How To Find a Plastic Surgeon: 

1.  Make sure he is a Board Certified Plastic Surgeon ( not just a Board Certified… doctor; or not just a Cosmetic Surgeon )

2.  Make sure that he has surgical privileges at area hospitals ( hospitals do your homework in terms of credentialling for you )

3.  Never have breast or body surgery by an Oral Surgeon, Dermatologist, Gynecologist, or ENT Otolaryngologist.

4.  Review before and after pictures particularly since we tend to post are average to better results.

How Does the American Board of Medical Specialties ( ABMS ) help you

The American Board of Medical Specialties is a professional not for profit organization which is recognized as the gold standard in ensuring the qualifications and certification of physicians.  It oversees 24 approved medical specialty boards in the development and use of standards in the ongoing evaluation and certification of physicians.  It believes that higer standards for physicians means better care for patients.  Importantly, hospitals approve physicians to work at their facilities based on whether the physician is certified by one of the specialties represented by the ABMS.  This means that in order for a physican to work at a given hospital, that physician is required to have completed a residency in a given field represented by the ABMS and that physician must have passed an “Board” exam which proves the physicians aptitude in that field.  How is this relavent to cosmetic surgery patients?  It is relavent because patients should know that hospitals is done some of the homework for them.  If the prospective doctor does not have privileges at an area hospital for the procedure he wants to do for you, this generally means that a hospital would let him do it because they were not qualified to do so.  This includes Dermatologists doing liposuctions and facelifts, Oral Surgeon Dentists and Otolaryngologists doing breast augmentations and tummy tucks.  Believe me when I say that this happens.  There are some doing this in Leesburg and Lansdowne.

*** Note that the Amercian Board of Cosmetic Surgery is NOT recognized the The ABMS.  And hospitals will in general not grant privileges based on this pseudo-credential.  It is a Board used by the unqualified for purposes of advertising.

Blog by Dr. Phillip Chang MD:  Plastic and Reconstructive Surgeon at Aesthetica with Offices in Loudoun and Fairfax Virginia

Breast Cancer now afflicts 1 out of every 8 women in the U.S.  Once diagnosed, most women must go through the agonizing consultation about how to treat their cancer.  Most women have either a surgical mastectectomy ( removal of the breast ) or a lumpectomy ( partial removal of the breast ).  Unfortunately, many women are left to wonder about what their reconstructive options are after the removal of their cancer.  Despite an increase of breast reconstruction procedures performed in 2008, nearly 70 percent of women who are eligible for the procedure are not informed of the reconstructive options available to them according to a recently published report  . Newly released statistics by the American Society of Plastic Surgeons (ASPS) shows that there were more than 79,000 breast reconstruction procedures performed in 2008 ( a 39 percent increase over 2007.). But in spite of this increase, current research suggests that many breast cancer patients aren’t offered their reconstructive options at the time of their diagnosis.

As a Plastic and Reconstructive Surgeon, my patients need informed choices no matter what procedures they might be interestedin.  In an informal survey of my patients  in Loudoun Virginia who have had breast reconstruction procedures from other surgeons, I have found that most patients were not informed of all the methods of breast reconstructions available.  Most patients were only given the options of breast reconstruction with breast implants or a breast reconstruction with their own tissue through a pedicled flap.  More sophisticated techniques such as reconstruction through a microvascular flapwere not offered.   Many patients are not offered the option of a microvascular DIEP or TRAM Flap reconstruction because it takes the most sophisticated techniques and the most technical experience.  And it is this last technique, that most insurance companies are decreasing their financial compensations for.

“Women need to understand all of their options to make an informed decision,” said ASPS President John Canady, MD. “Those who are diagnosed should be immediately referred to a full team of physicians that can provide breast care, and plastic surgeons need to be included as part of that treatment team.”  This team should include their primary care physician, an oncologist, general surgeon, pathologist, radiologist, as well as a plastic surgeon.

The ASPS is launching an ongoing effort to bring public awareness to breast reconstruction issues, including education, access, and a team approach. Because early involvement by plastic surgeons and other physicians can allow development of an optimum treatment plan for each individual patient, collaboration amongst specialties is essential.  This team approach allows for the patient to not only have the best chance at a cure from their breast cancer but the optimum opportunity to have an excellent cosmetic result.  It is also important that patients actively participate in their treatment. Though a common misconception, eligible patients should not assume that anyone other than a board-certified plastic surgeon affiliated with an accredited facility is qualified to perform breast reconstruction. While technology has made breast cancer diagnosis, treatment, and reconstruction better than ever, it does not negate the need for medical expertise within each specific area of care.

Blog by Dr. Phillip Chang, M.D. :  Offices in Leesburg in Loudoun, Reston in Fairfax, and Winchester.

Adapted from a Story by the American Society of Plastic Surgeons.

About ASPS
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada

History of Nasal Reconstruction

The art of plastic surgery started over two thousand years ago in Ancient India.  In that time, shameful crimes such as adultery were punishable by amputating the convicts nose and/or ears.  The first nasal reconstruction procedures were most likely reconstructive rhinoplasties ( nose jobs ) to repair noses and ears that were mutilated after this form of punishment.    The art of nasal reconstruction was most likely further developed in the treatment of soldiers who lost body parts lost in battle.

Hindu surgeon Sushruta, working near the modern-day city of Varanasi described the “attached flap” method of plastic surgery in his 600 B.C.   The technique was described in his writings called the Sushruta Samhita. The procedure involves reconstructing the nose by cutting skin from either the cheek or forehead, twisting the skin skin-side-out over a leaf of the appropriate size, and sewing the skin into place.   The modern methods for nasal reconstruction were derived from these original descriptions, and really haven’t changed dramatically since that time.  To keep the air passages open during healing, two polished wooden tubes would be inserted into the nostrils. This method of nasal reconstruction became known as the “Indian Method of Rhinoplasty” and was kept secret for centuries in India.

Blog by Dr. Phillip Chang, MD:  Offices located in Fairfax, Loudoun, Winchester Virginia.

Blog By Dr. Phillip Chang:  Board Certified Plastic Surgeon with Offices in Loudoun, Winchester, and Fairfax Virginia.

According to the American Society of Aesthetic Surgery ( www.surgery.org , over 10.2 million cosmetic surgical and nonsurgical procedures were performed in the United States in 2008.    The Aesthetic Society has been collecting multi-specialty procedural statistics since 1997.  They state that the overall number of cosmetic procedures has increased 162 percent since the collection of the statistics first began. The most frequently performed nonsurgical procedure was Botox injections and the most popular surgical procedure was breast augmentation. Here in Virginia, in my offices in Loudoun and Fairfax, I have also seen this change, particularly after the introduction of silicone implants.

“For the first time in the twelve years these statistics have been collected liposuction is a runner up in popularity to breast augmentation. There is no doubt that this turnabout will generate discussions in the medical community and the public at large,” said Alan Gold, MD, Aesthetic Society president;  These statistics reflect that “changes in fashion, i.e. décolletage baring styles, might be a factor behind this change.”  Last year, there were 355,671 Breast Augmentation procedures.  Over the same period, 2,464,123 patients were administered Botox.

Although there are many patients who decide to have a breast augmentation when they are younger, the majority of patients decide to undergo a breast augmentation procedure to simply restore and rejuvenate their breasts after having children.  Most of these women would share that pregnancy caused their breasts to lose volume and sag a little or a lot.  Some would say that their nipple-areola complex also got larger.  These women simply want to return to some semblance of what they might have looked like before having children. 

Breast Augmentation

Breast Implant

Loudoun, Winchester, Fairfax, Virginia

Blog by Phillip Chang, MD:  Board Certified Plastic Surgeon with Offices in Loudoun, Winchester, and Fairfax Virginia

You might be thinking, “What does a plastic surgeon know about solving the health care crisis?’”.  Well, I happen to think I am well situated to have all ( ok… many) of the answers.  It may come as no surprise that a good percentage of my patients are overweight.  In discussing their lifestyles, I have given a lot of advice through the years on how to how to treat my patients surgically as well as on how to maintain their improved image after their procedures.  Often, this conversation begins with what are you doing for exercise, what kind of diet do you eat, and how much weight have you lost?  Believe it or not, I have a stake in having my patients maintain their appearances after a tummy tuck or liposuction procedure, or part of a Mommy Makeover.  I have found that most of my patients do what I call- Binging on Lifestyle Changes.  That is, they start an intense work-out regimen that is not sustainable ( for the average person )… or start a diet that is impracticable or unproven ( for almost anyone ).  They do this without the basic understanding that they would be better off by simply making minor lifestyle changes.

I recently posted a link to a Time Magazine article entitled “Why Exercise Won’t Make You Thin“.  ( http://www.time.com/time/health/article/0,8599,1914857,00.html ).  The article had the premise that exercise in and of itself is not the solution to weight loss.  50% of Americans are technically “obese”.  This article lead me to think about all the patients in my office who struggle with weight loss.  Contrary to popular belief, most women ( and men ) who come to my office don’t come in trying to use plastic surgery as a quick fix to weight loss.  My patients often struggle for years before they have the courage to step through my doors.   More often than not, they have joined gyms, hired physical trainers, bought treadmills, exercise bikes and/or  boxing gloves.  All to no avail.  At the same time, these patients, are also afflicted with busy lives which predispose to unhealthy lifestyles.  Many are stay-at-home moms who find it hard to lead active lives while they struggle with taking care of their families.  Others have stressful metropolitan jobs that don’t allow them to be active and encourage poor dietary habits.

I believe many of the suggestions of this article are true.  Namely, I believe that rebound eating is a norm after “exercising”.  I see too many people trying to take an hour out of their busy days to exercise while the rest of their day remains sedentary.  I see even more people eat poorly throughout their days using the fact that they exercised as an excuse.   I have seen people diet only to fail in their diets because dieting ( which should not be confused with eating healthy in moderation ) is an unnatural behavior.  Researchers have pointed out that there is NOT A SINGLE DIET that has ever consistently lead to weight loss over an extended period of time.

The Time Magazine article suggests that Exercise in and of itself is not the solution.  There is the implication that increasing your normal daily activity as part of a lifestyle change is the solution.  Take walks, join a sport, ride a bike to work, take the stairs, etc.  Whether because exercise makes us hungry or because we want to reward ourselves, many people eat more — and eat more junk food, like doughnuts — after going to the gym. And don’t start the new fad diet.  Eat healthy, including proteins ( which decrease your appetite over time ) and decrease carbohydrates and oily foods.  But eat normal portions to prevent binge eating.

Reading this article and trying to relate it to my patients, I have developed some solutions to the health care crises.  These beliefs are based on the following facts:

1.  Americans live very unhealthy lifestyles compared to the rest of the world

2.  Americans are addicted to fast food and unhealthy processed foods  ( watch the movie Super size Me- its a classic )

3.  Americans live sedentary lives compared to the rest of the world

4.  Obesity predisposes to diabetes, hypertension, and further decreases in activity

5.  The problems with dieting and exercise are that they represent short lasting, self limiting activities that are often difficult to sustain.  For example, how often have you are people you know started on a diet or exercise regimen only to fail the first time the routine is interrupted )

Based on these principles, I believe that trillions of dollars could be saved if people simply walked to work and took the stairs, stopped smoking, stopped drinking, and ate healthy meals in moderate portions ( not dieting ).  I believe that millions if not billions of medical health care dollars should be redirected toward a national campaign to encourage healthy lifestyles; trillions of dollars could be saved.  Note that 75 percent of all health care dollars are now spent on treating hypertension, diabetes, cardiovascular disease, and lung diseases associated with obesity and smoking.  You might think that the national government would further encourage the cessation of smoking, and encourage lifestyle changes amenable to weight loss.  The present health care debate is misplaced and misdirected.  The answer is not in nationalizing the health care system.  Government run systems in general waste our tax base.  We already have two examples of nationalized health care in the United States; that is the Veterans Administration and the Military Health System.  Anyone who has used either system knows that both are inefficient bureaucratic behemoths.  We should be encouraging healthy lifestyles instead.  That is my two cents…. don’t even get me started on Tort Reform!

Antioxidant Fruits Fight Disease While Building Up Collogen

Blueberries , Acai Berries, Cherries, Pomegranates

It is a biological paradox that we breath in oxygen; our cells require it for metabolic energy, however, like the exhaust smoke that comes out of your car, the oxygen is broken into poisonous by-products call oxidants that poison the body unless is is broken down by “antioxidants”.  Antioxidants can both prevent the formation of these oxygen radicals as well as or dispose of their waste.

It appears that people who eat fruits and vegetables, which happen to be good sources of antioxidants, have a lower risk of some cardiac and neurological diseases, and even some types of cancer.   Other diseases which appear to be protected by antioxidants include macular degeneration,  immune deficiency diseases, and neurodegeneration.

Some Well Known Examples of Antioxidants include:

• -  Vitamin E
• -  Vitamin C
• -  Melatonin

Antioxidants also appear to increase collagen production and improve the quality of the collogen that already exists.  Collagen can be thought of as the resilient shell that surrounds the cells in our skin and organs.  With respect to aging, as the collagen breaks down, the skin loses its strength and elasticity— leading to loose skin and wrinkles.  Antioxidants theoretically increase collagen production and thicken the skin, making you look younger and healthier.

Collagen production unfortunately decreases with the aging process.   However, through a healthy diet of dark fruits which typically are rich in antioxidants, we can fight some of the effects of the aging process.   Fruits like blood oranges, cherries, blueberries and the acai berry are full of antioxidants which may which may slow aging and disease by lowering inflammation. Antioxidants also decrease the severity of rosacea.

At Aesthetica, I hightly encourage my patients whether they are coming fin for a tummy tuck or a facelift to eat healthy.  I believe that antioxidants have the ability to decrease inflammation and speed up the healing process by increasing collagen production.  I believe a healthy diet and a healthy lifestyle goes far beyond what I can do surgically.   The longer you look good, the better I look to you your peers.

Other examples of Antioxidant Fruits include:

• Blackberries
• Raspberries
• Plums
• Pomegranates
• Asian Dragon Fruit
• Kiwis

Blog By Dr. Phillip Chang, MD:  Board Certified Plastic Surgeon with offices Loudoun, Winchester, and  Fairfax Virginia

Volumizing the Brow with Hyaluronic Acid Fillers

The following is excerpted from the Press Release Center of the American Society of Aesthetic Surgery.

How do you judge a good nose job?  A good plastic surgery procedure is one that provides not only an improved appearance but one in which the rest of the world wouldn’t be able to tell that anything had been done. The surgeon that can provide this has to be a good artistic plastic surgeon and not merely a plastic technician. It upsets me when I walk through a grocery aisle and see the tabloid magazines pointing out how this celebrity or that celebrity had a bad cosmetic procedure- as if all plastic surgical procedures turn out badly. The way I respond to my patients is that the vast majority of procedures turn out fine, that they would be surprised how many of their neighbors have had procedures, but they might never know it because they turned out well.

A good example of what I am talking about is Ashlee Simpson. Simpson reportedly had a nose job in April 2006. When asked about it in an interview in May, Simpson neither confirmed nor denied it. In the May 2007 issue of Harper’s Bazaar, she said that she was not insecure about her appearance and had not been beforehand. She later stated that “as long as people have two eyes” they could determine for themselves whether she had a nose job.

Ashlee Simpson- Before and After

See My Before and After Pictures at :  http://fairfaxplasticsurgeon.com/rhinoplasty.htm

Here is a celebrity starlet who underwent the procedure for her own reasons… probably because she didn’t like the appearance of her nose. And regardless of the reasons for her procedure, some people needed to speculate whether she had the procedure at all. And finally, there is no doubt that the appearance of her “new” nose is attractive, natural, and improves her overall appearance. Kudos to her plastic surgeon.
Rhinoplasty procedures can be one of the most satisfying and life-changing procedures in cosmetic surgery. I have patients that range from 17 years old to 70 years old who come in with complaints about the appearance of the nose. The nose is after all, the central feature of your face.  Rhinoplasty procedures are becoming one of the most common procedures performed by plastic surgeons.  Typical complaints include:

• my nose is too large
• my nose is too small
• my nose has a bump
• my nose has a drooping tip
• my nose has a big tip
• my nose is too large
• my nose is crooked

What most people don’t realize without coming in for a consultation is that not all of these procedures require a surgical nose job.  Some of these issues can be addressed non-surgically.  I was one of the first plastic surgeons according to one of my filler representatives to use cosmetic fillers such as Radiesse, Juvederm, and Restylane to address the cosmetic appearance of the nose.  To some degree, all the complaints can be addressed with one of these fillers, without surgery, and no need for recovery.  Radiesse lasts between 1 and 2 years.  Juvederm and Restylane can last up to 1 year.

 At least half of my patients benefit more from a Surgical Nose Job.  The goals, of course are to provide an improvement that appears natural.   If you look at my before and after pictures on my web site ( www.GoToBeauty.com or www.fairfaxplasticsurgeon.com ), you will see that I attempt to provide my patients with an attractive appearance and an appearance of never having had a rhinoplasty.  I spend a lot of time performing revision rhinoplasties on patients from other offices where the results are not as natural.

 The first step is an initial consultation which is complementary.  During your consultation, we will discuss your image with some digital imaging software.  We will discuss your complaints and desires come up with a plan that fits your desired image and lifestyle.  Sometimes this means a non-surgical option, and sometimes it means a surgical rhinoplasty.

Blog by Dr. Phillip Chang, M.D. :  Board Certified Plastic Surgeon with Offices in Loudoun and Fairfax, Virginia.

Attached is an article excerpted from the American Society of Plastic Surgery. The finding point out that the use of nonsurgical methods of cosmetic improvement such as the use of Botox and facial fillers has become mainstream.

NEW YORK, NY (June 1, 2009) — Despite what some may think, people aren’t hiding their use of BOTOX® Cosmetic and hyaluronic acid dermal fillers. In fact, according to survey statistics released today by The Aesthetic Surgery Education & Research Foundation (ASERF), the research arm of the American Society for Aesthetic Plastic Surgery (ASAPS), nearly nine out of 10 respondents (87 percent) openly discuss their BOTOX® Cosmetic and hyaluronic acid dermal filler treatments with others, with seven out of ten (70 percent) receiving support from the people they told.

“In a similar survey issued four years ago, we dispelled the myth that Hollywood and corporate wives were the typical BOTOX® Cosmetic patient,” says ASERF President Laurie Casas, MD, a plastic surgeon practicing in suburban Chicago. “Now, demographic and perception data trends show us that aesthetic injectable treatments have continued to evolve into mainstream and accepted options for the everyday woman.”

• 90 percent of patients who get botox openly discuss it
• Typical recipient is a working mother 41-55 years old of modest incomes
• Younger patients are beginning to have treatments with botox to mantain their appearances of youth
• Patients are treating their “angry lines” and “worry lines” with botox and their “parenthesis lines” around their mouths

Survey results found that the typical aesthetic injectable patient is a married, working mother between 41-55 years of age with a household income of under $100,000. The survey also found that women receiving aesthetic injectable treatments are health-conscious and philanthropy minded, with the majority incorporating exercise (95 percent) and healthy eating habits (78 percent) into their lives, and many volunteering with charitable organizations that matter to them (32 percent). In addition, nearly seven out of 10 respondents believe that BOTOX® Cosmetic (72 percent) and hyaluronic acid dermal fillers (65 percent) are important parts of their aesthetic routine.

“Interestingly, among BOTOX® Cosmetic patients, nearly seven out of 10 respondents also received treatment with hyaluronic acid fillers,” says Dr. Casas. “Most people have great success with BOTOX® Cosmetic and dermal fillers; however, we need to make patients aware that even though injectables are not ‘surgery,’ their administration is a medical procedure with risks that depend on the training and experience of the clinician, the clinical setting and the technique used.”

Additional findings of the survey found that 72 percent of respondents received BOTOX® Cosmetic injections to treat their glabellar lines – also referred to the “11” – the frown lines in between the brows, while 63 percent of those surveyed received hyaluronic acid dermal filler injections to treat their nasolabial folds – also known as the “parentheses” – the lines around the nose and mouth. A few of the most frequently cited reasons to receive treatment with BOTOX® Cosmetic was “to look more relaxed, less stressed” while patients reported choosing treatment with hyaluronic acid dermal fillers to “look more rejuvenated.”

Based on its annual survey of U.S. physicians performing cosmetic procedures, ASAPS recently reported that BOTOX® Cosmetic injections have remained the most frequently performed procedure since FDA approval of the product in 2002. Hyaluronic acid dermal fillers ranked as the third most popular procedure performed last year. ASERF conducted this follow-up survey to quantify the characteristics and opinions of the patients who receive the treatment to help its members and the public obtain a better understanding of these important modalities.

Blog by Phillip Chang MD ( Aesthetica Cosmetic Surgery and Laser Center )  serving Loudoun and Fairfax in Northern Virginia

According to a new survey by the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery, attitudes about self-image and the desire to improve self image through cosmetic surgery change depending on your age and stage in life. Visitors were asked “What aspect of physical beauty do you find most appealing in another person?”

Interestingly, most younger patients ( 20s through 40s ) valued the appearance of their bodies over the appearance of their face. As they got older ( 50s through 60s ), the feelings of body image evolved. These patients came to value the appearance of their faces more than their bodies.

· Respondants in their 20s through 40s responded that they valued a fit well proportioned body the most

· Respondants in their 50s and 60s responded that they valued youthful skin the most

These finding reflect what happens in my practice.  I have offices in Loudoun, Winchester, and Fairfax, Virginia.  This is one reason why my “Mommy Makeover” procedure has become so popular. Women in their 20s through their 40s value the appearance of their bodies in when they are in their 20s as they search for potential partners. These same patients, however, once they have a partner and begin to have children struggle with their body image because of how having children change the appearance of their bodies. The mommy makeover procedure usually addresses the changes to their breast ( through an augmentation and/or a lift ) and their belly ( through a tummy tuck and/or liposuction ).

As a woman approaches their 40s and 50s, these patients begin to focus more on their face and skin. This makes sense as our facial features begin to change around this time. The skin loses elasticity, and years of sun damage begin to take its toll on skin quality. These are the patients make up a large part of my practice. In general, these patients come in for:

· Mini Facelift to address laxity in the skin and jowls

· Facial fillers ( Juvederm, Radiesse, or Restylane ) to improve the appearance of deep facial lines such as the “ parenthesis “ line around the mouth and to fill in the loss of facial volume in the lips and cheeks

· IPL ( Photofacial ) to treat sun damage and dark spots

· Botox to treat the lines of the forehead, glabella, and crows feet.

Finally the respondants were asked why they would have cosmetic surgery? The most common answer was to boost self-confidance. To boost self-confidence was the top choice for all decades. The second place answers depended on the patient’s age.

1. 20s- To attract potential partners

2. 30s- Increase professional opportunities

3. 40s- Increase professional opportunities

4. 50-60s To help make friends

It is always important to understand what our patients are most concerned about at different stages of their lives. We want to be equipped to help our patients make the right decisions to maintain their beauty at every age—no matter which type of cosmetic medical procedure they are interested in.

Another question asked members to contemplate “The most important factor in maintaining beauty.” While adherence to a healthy diet, regular exercise and skin care were popular choices, approximately one in five members felt that a cosmetic medical procedure was most important in the 50s and 60s.

Blog by Phillip Chang MD:  Board Certified Plastic Surgeon with Offices in Loudoun, Winchester, and Fairfax Virginia