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2019 Let This New Year Inspire You to Take Better Care of Your Health

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Start With Your Skin — First Impressions are Everything

New Year’s resolutions can be sustained as long as you make resolutions simple, thematic and turn them into a habit. Do not think of your resolution as a single task to prevent your brain from shutting off the good habit once it has been performed once or twice. Sustain them even if you miss one week…do not let one week become 3 months.

Let 2019 be the year of better health. That can mean better food choices, smaller portions, fewer starches/carbs, scheduling a 20 minute walk per week, one work out class per week…simple healthy choices that you can make a HABIT.

Consistent daily skincare is essential for your health. This habit translates to beautiful skin if you use the correct medical products for YOUR skin needs and skin type.

What are the correct products for YOUR skin?

1. An anti-oxidant serum, such as Dr. Koo’s GLOSS Vitamin Serum, that protects against the formation and the penetration of super-oxide free radicals that damage skin (wrinkles and uneven pigmentation) and go on to cause skin cancers. Pollution and UV rays are the greatest producers of free radicals in our skin. Layer the anti-oxidant serum under daily sunscreen, makeup, and all other products EVERY DAY, TWICE A DAY.

2. Use the appropriate skin cleanser to remove dead skin cells. This does not mean using harsh cleansers or brushes which will irritate and redden the skin. Harsh detergent cleansers or too frequent washing will strip your own skin’s natural oils thereby stimulating your oil glands to overproduce oil. This will lead to the opposite of what you want; it will create breakouts, clogged pores, and even more oily, rough, and irritated skin.

  • Use gentle GOOD quality cleansers for your skin needs.
  • Dry/Very Dry Skin: use a creamy cleanser
  • Oily/Acne Prone Skin: use either a clarifying or exfoliating cleanser
  • Congested Pores/Rough Skin: use a gentle cleanser with TINY ORGANIC  crystals (Dr Koo POLISHING CLEANSER) to cleanse the pores without aggravating them with harsh scrubs
  • The appropriate cleanser will allow the actives you use to penetrate and fulfill their purpose.

3. Use the correct level of moisturizer your skin craves. If you have dry to very dry skin, you will need a cream AND perhaps a more rich dense serum. Your own skin’s level of moisture will determine the level of moisture product (Dr Koo BOOST) required. Moisturizers should be applied twice daily, under makeup and with the GLOSS Vitamin Serum.

The weather and temperature will determine the frequency of use. If you are in a high altitude in a dry climate, you may need to moisturize even more than twice a day. If you are in a temperate, humid climate such as Florida, you may only need to moisturize at night.

The season and how your skin responds to the products will guide you to the frequency of use.

The above 3 products are the most basic and most important products you must use. If you are in your 20’s or 30’s, those are the ONLY products you need (anti-oxidant sunscreen of course also)!

If you have pigment, wrinkles, and thin skin concerns, you will also need an anti-pigment and retinol product such as Dr. Koo’s REJUVENATE & GLOW products.

The correct level of Retinol/REJUVENATE product is used at night only and will increase the thickness (plumpness) of your skin. REJUVENATE will lessen the appearance of the fine and deep wrinkles. In combination with the correct PIGMENT product (Dr Koo’s GLOW), your blotchiness/pigmentation will lessen and the skin tone will appear milkier, smoother, and more even.

5 products plus a sunscreen is the maximum amount of products you honestly need. Additional products are only if you have particular concerns of redness/ruddiness, thin crepe-like eyelid skin, significant acne, or very sun damaged skin.

Your skin is a dynamic changing organ. In fact, your skin is the largest organ of your body and deserves continued care due to its constant exposure. You will help your own systemic health AND the health of your children if you take care of yours and their skin CONSISTENTLY and early-on!

The beauty will follow the functional care of your face.

I haven’t even started on the protection of your neck, chest and knees!!! Stay tuned for the next BLOG!

xo Happy New Year, let the intrinsic reward of healthier and therefore more fresh looking skin and health motivate you to continue the routine!!!

Dr Koo Skincare for Health

How Do I Choose the Perfect Breast Implant for Me?

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My patients ask me this question during every consultation.

My reply is: it has taken me 25 years of experience to really understand, to truly “see” how an implant will fit a patient’s breast, chest wall, rib cage, lifestyle, clothing choices, comfort level…let me be your expert and I will pick the perfect implant with you depending on what you want, your body, and your lifestyle.

I say don’t worry about the size or shape of the implant, simply look at pictures of your perfect world breasts, and “shop the look.” Bring me the pictures of the size, and “look” of the breasts you love, and I will match that  “look” for your body size, breast shape and desires!

The most important point for you is, what look are you going for? What is your comfort level with the amount of attention your breasts will receive? What type of neckline do you like to wear? Do you simply want to have some fullness and firmness in a swimsuit? Do you not want anyone to notice? Do you want a little or a lot of curves?

Everyone is different. Every breast and rib cage is different even from one side to the other. These tiny nuances and details are what I pay particular attention to in order to achieve YOUR perfect breasts.

YOU only have to “shop the look” and ask yourself what you want!


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  • Hyaluronic Acid microsomes diminish eyelid wrinkles, puffiness, and dark circles. Rejuvenates and restores the delicate upper and lower eyelid skin. Squalene, Arginine, & Proline enrich and penetrate the skin cells to smooth the eyelid skin. Prevention and maintenance are your best anti-aging solutions!


  • Intensely concentrated Tocopherol, Jojoba Esters, & intense anti-oxidants diffuse and lighten photodamaged pigmented skin spots. Excellent for the very stubborn pigment age spots. Precise application tip targets pigment spots.


  • Prevents and calms hormonal acne breakouts. Alpha Lipoic Acid & Buffered Salicylic Acid extract toxins, blackheads and oils to shorten acne breakout without overly drying or irritating blemish prone skin. Quiets the angry red stage to help prevent long-term scarring.

To view and learn about all of Dr. Koo’s Skin care products visit Dr. Koo Premier Skincare site

Too Much Sun When You Were Young…Do You Look Older than Your Chronological Age?

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Many of my patients tell me they look so much older than their actual age. What is the reason for this? Let’s start with the basics:

  1. Too much sun exposure during the teen and young adult years and continued lack of sun protection.
  2. Years of smoking.
  3. Early loss of one’s own hormones (early menopause).
  4. Poor skin regimen with ineffective skin products.
  5. Poor nutritional choices.

The number one offender is too much sun exposure. The sun damages the skin cells (keratinocytes) and the arrangement of the collagen and shape of the cells. All of this damage leads to rough, unevenly pigmented skin that is leathery and crepey appearing.  Inhaling nicotine and various toxins associated with smoking also causes direct damage to the cells and the blood vessels that supply the entire body as well as the skin. The loss of hormones can also profoundly affect the quality of skin also. Your choice of foods can also be a factor if you already have trouble prone skin i.e., acne oily prone skin. Drinking more water, and cutting out sugary carbonated sodas can lessen this last offense. The more green the choice of your vegetable the healthier it will be for your skin.

The best advice for your food choices: try to avoid any food that you have to open a can or unwrap a wrapper to consume. The fresher the food, the more natural the state of the food, meaning having to cook it yourself, the better nutritional value it will have and the healthier it will be for you.

Your best weapon to undo the previous wrongs committed against your skin is to start using sun protection EVERY day and cut down (or quit) smoking. I am not a fan of taking exogenous (supplemental) hormones after menopause, but I am a strong proponent of taking vitamin supplements to make our cells more efficient and be able to perform as previously (produce more normal collagen, more tiny capillaries, normal pigment).

I also believe that medical quality skin products can make a significant difference in the skin quality, color, and texture. These products need to contain true tested pharmaceutical active components NOT simply COSMETIC ingredients you can purchase at the drugstore or mall.

I have technologically engineered skin products formulated specifically by my formulating pharmacist and myself! The natural products and their derivatives are blended in a proprietary technique to drive the actives much more effectively into the actual skin cells to stimulate the cells to return to normal function. This translates to healthier, more brilliant appearing skin erasing much of the damage.

The catch: you have to use it on a regular basis! That part isn’t rocket science. This is truly the best value for your money spent. You spend more money at Walgreen’s, CVS, and Target on products that fill your bathroom cabinets that do nothing for your skin. The products have little penetration and the ingredients that do penetrate do nothing to actually change your skin quality.

If you start on the products and don’t see any change after CONSISTENTLY using them following my instructions in 8 weeks, I will refund your money. You may need to add or change one of the products but my office and I will get the correct combination of products for your skin type! We also will continue to progress your skin to more concentrated and intense components as your skin improves to make sure you are achieving the most you can from your medical skin care.

Do Breast Augmentations have to look big and… fake?

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The answer is no! A breast augmentation with breast implants can simply fill in your skin envelope and take up the slack in your breast skin.

If you see yourself as an athletic person, and you’ve always had smaller breasts but now after children, you don’t have any roundness or shape to your breasts, you can have a breast augmentation and still have small but now rounded, more firm and more pleasing breasts.

The key to remember is that breast augmentations are not always about size! It is about the look!! Some of my patients do want very large “fake” breasts and they are very comfortable with that look and I make sure I achieve their perfect world desires.

For those who want a change in shape but not much of an increase in size I feel it is important to address the following issues with your plastic surgeon:

  • How much roundness you want
  • How high on your chest wall you want your breasts to start, how full on top
  • How much “side boob” curvature you want
  • How much cleavage you want
  • And especially important is how noticeable you want your breasts to be on your body

A small volume breast implant with the appropriate projection and fill ratio (firmness) can create soft, natural, well proportioned breasts that are well balanced and elegant for your body size and compatible with your lifestyle.

I try to discuss all of these points with my patients and try to understand your lifestyle to help direct your ultimate decision for the size, shape and LOOK you want. I find it much more important to discuss the look rather than the size. There is too much variability in bra cup sizes to finalize a breast augmentation based solely on cup size. In my communication with my patients, it is imperative I understand the LOOK of your breasts you want to achieve.

Furthermore, if you haven’t finalized the shape and look that you want, it would be impossible for your plastic surgeon to pinpoint it for you at the time of surgery. This must be discussed and agreed upon prior to your surgery.

Take home point: breast augmentations are very safe and you should be able to achieve whatever size and look you desire, but you must have that LOOK well defined in your mind and show your plastic surgeon that LOOK before the surgery!

How Do you Find the Right Breast Implant for Your Breast Augmentation??

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You’ve wanted a breast augmentation for such a long time and now you’re at least ready to start the interviewing process for the right plastic surgeon. Now the real question is how do you know what the right breast implant is?

I feel it is extremely important that you tell your plastic surgeon about your lifestyle, profession and activity level. If you are a teacher and really don’t want your friends and pupils to notice your new breasts or make ANY comment at all, you may want a lower profile softer sitting implants that allow some fall and roundness.

If you are a Mom of young children and teenagers, you may especially be self conscience of being noticed. You want some sexiness and fullness but above all you want your breasts to look natural and in proportion to your body. In this case you will want a full implant but one that is perhaps smaller in width and a little more firm to give your breasts a slight lift in addition to the volume.

If you are in your 20’s and you’re looking for a breast augmentation, the sky is the limit. The choices will truly be only limited by the anatomy of your breasts and your desires. If you want to rock full, sexy, up in your face breasts, you should have them with a full profile, firm, wide breast implant.  You can also choose to have a slightly softer fill implant if you want to only have them in your face when YOU want to show them off with a push up bra or in a swim suit. The exact type and size of breast implant will be determined by your plastic surgeon. Don’t make the mistake of dictating the actual cc size of the breast implant. Your plastic surgeon will place sizers in to determine the perfect fit.

The take home message is have many conversations with your plastic surgeon and ask many questions. Tell her/him about your concerns, if you are planning to have children, breast cancer history, the type of skin you have, the amount of time you spend in the sun, your profession, exercise routine, etc etc etc, in essence everything about your life you think is important actually.

If your plastic surgeon doesn’t want to hear all of your concerns or someone other than your surgeon is talking to you, run for the door. Take the time and make the effort to know the quality of the person your plastic surgeon is!

Breast augmentations are extremely safe and you should have a wonderful experience obtaining the perfect breast enhancement for YOU!!

Enjoy the process—

CELLULITE….What the …. is it? How Do I Get Rid of it?

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If you have cellulite you are certainly NOT alone. Most women and many men have the same problem. Some have a very mild case of it so it is not very noticeable and some have severe cases of it that they do not feel they can wear shorts or even tighter clothing for fear that the cellulite will show through the clothes.

Some researchers and physicians believe cellulite is a normal fat distribution that occurs more in women than men and can be linked (not necessarily caused by) to hormones, genetics, diet, and lifestyle choices (such as smoking, obesity, dehydration and lack of exercise).

Cellulite is an enlargement of normal adipose cells in the superficial layer of our skin. Everyone has these fat cells but when they enlarge and stretch the skin and tether the normal intermittent fibrous bands in our skin, the end result is a dimpling appearance in our skin.

Cellulite typically becomes noticeable during adolescence during weight gain and increase in circulating hormones. This does not occur in everyone and even occurs in people who are thin.

Unfortunately, there is nothing you can do to prevent cellulite specifically if you are predisposed to it with the genetics of your body type and fat cell type. However,….sensible lifestyle choices of regular exercise, not smoking tobacco, adequate hydration, and healthier food choices of dark green vegetables and fewer carbohydrates will all help to deter and minimize the sometimes inevitable development of cellulite. Maintaining a healthy (not thin but healthy for your genetics) weight is key.

The treatment options are varied and many, and again unfortunately not very effective. There is currently an FDA approved laser for the treatment of cellulite but the results are minimal and subjective in my opinion. Liposuction while it improves the contour and shape to perhaps make cellulite appear less noticeable, it can actually also worsen the appearance of cellulite! Mesotherapy, injection of various medications and vitamins have not been proven to reduce cellulite and fat and can cause more irregularities, swelling, skin changes, and infection.

Spa treatments and external massage and wraps are temporary. The results are most likely due to temporary removal of the water content of the superficial and deep skin and fat layers.

Creams and lotions are extremely tempting but costly and a waste of your money!

What lies ahead for cellulite treatment? I know I sound like a skeptic and a naysayer, but the truth is there is ongoing research for certain wavelengths of light (lasers) that may disrupt fat cells and cause them to shrink but these are only at the research stages.

DR KOO’S ADVICE: Try to prevent cellulite from worsening by staying within your ideal weight zone to begin with; make healthy food choices and engage in regular aerobic exercise with weight training incorporated. This doesn’t mean you can’t occasionally eat or drink what you like, but key concepts are limits, portions, and continue to make the right choice EVERYDAY NOT JUST WHEN YOU FEEL LIKE DIETING.

Been Considering Breast Enlargement Since You Were A Teenager?

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Now how do you go about accomplishing this? How do you get the perfect size breasts for your body? How do you find the right plastic surgeon that will understand what it is you want?

More importantly, how do you get your St. Louis plastic surgeon to understand it is not only about the size of the breasts but the shape of the breasts? Do you also need a breast lift along with a breast implant?

How do you convey the desire for a rounded, shapely breast that still has a natural fall, some “side boob” but not armpit breasts? Breasts that aren’t too obvious and still professional but are still big enough to be sexy when you want to be?

The answers to all these questions should come from your plastic surgeon before you even ask them.

The truth is there are so many sizes that would be perfectly compatible with your body — the deciding factor is your personal comfort level with how full the breasts become.

By that I mean, how noticeable do you want your breasts to be? How much do you run and what types of exercise do you enjoy? How do you envision yourself — athletic and slim or full bodied and curvy? How tall are you? How much do you weigh? Have you had children? Do you plan to have more children?

Those answers will determine what type and size breast implant I recommend for my patients. I always discuss size and shape while looking at actual photographs with my patients. This will give a visual reference point that is so much more accurate and meaningful than discussing the bra cup size or implant size.

These are excellent starting point questions you should always discuss with your plastic surgeon prior to a breast enlargement. Talk to other patients and consult with your plastic surgeon as many times as you want until you are completely sure and comfortable with the surgical plan.

Remember, ultimately the choice is yours and it is up to the plastic surgeon then to guide you, inform you, and understand what it is YOU want!

Does Plastic Surgery of the Face Always Look Peculiar and “Done”?

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When I am performing facial aesthetic surgery, I respect the natural architecture of the entire face. I respect the natural lines that are the patient’s unique look. I replace the skin and tissues to where they were previously; I don’t change the inherent structure.

Mickey Rourke or Renee Zellweger illustrate exactly my point. Their unique facial structures have been obliterated by their plastic surgery. Whether they’ve been overfilled or over pulled, it’s not a good look.

I recreate the natural and individual beauty of my patients’ former youth by replenishing and repositioning. This is the key to looking rested and not “done”. I completely understand and respect the soft tissue AND skeletal anatomy.

Meticulous attention to the positioning of the eyes, nose, and mouth within the face is imperative. I balance the face in its entirety therefore my patients never look odd or incongruous. For instance, addressing the neck without attention to its relation to the rest of the face creates a mismatch and a “done” pulled look.

A layered comprehensive approach with filler, BOTOX, skin care, and mini office eye and face-lifts can continue to keep the aging process in check. You can continue to look better and better without creating a significant one-time change. Again the key is regular maintenance. The subtle layered approach is especially important for MEN. As men age, their eyes narrow and brow drops and that becomes a sexy distinguished look that can be enhanced and tweaked but not entirely changed. Men especially do not look appealing with the “wide eyed surprised doe in headlights” look.

The maintenance should start as early as the teen years with acne prevention and sun protection. This will prevent long term scarring and the irreparable deep creases from sun damage. The pigment changes of aging skin can also be prevented and reversed with early intervention and regular maintenance. Medical strength products will achieve far more than any over the counter “feel and smell good” lotions. This is the only way to truly prevent skin damage and restore the luster and sheen of youthful skin.

Bottom line: See your Board Certified Plastic Surgeon early and often. It is better to do a little at a time than too much at once.

If I Have Plastic Surgery On My Face Will I Still Look Like Me?

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facephotoThis is a question I often hear during my office consultations for facial rejuvenation. My philosophy is that well-done plastic surgery makes you look rested, with softer smoother features not create a face and eyes that look pulled and “done.”

This is especially true for male plastic surgery. If you’ve seen pictures of Kenny Rogers or Mickey Rourke, you’ll know exactly what I’m talking about. They’ve lost the natural architecture of their faces and are not recognizable. You can see that result also if you Google Uma Thurman and Renee Zellweger.

So what happened to them? Did they not know where to go to get the best possible results? I don’t know what these celebrities requested during their consultation with their plastic surgeons but I feel it is my job to guide you as to what the best approach is to achieve an extremely natural improved look that allows you to completely keep your own features. I replace the tissues to their previous positions to achieve the very natural rested look.

‘LESS IS MORE’ is my approach when addressing the face, especially for men!

My job is to advise you what can and cannot be achieved and the best way to do it. I respect the natural contours of the face and eyes. Sometimes it is better to do a little at a time during the rejuvenation process. I term this the layering effect. This technique allows you to continue to improve slowly to achieve an unaffected look.

The answer to the question is, of course, yes you can look unaffected if you take the layered approach to rejuvenation. You can always do more but it is really difficult to correct what is overdone!! You don’t need to do it ALL at one time and the mission is NOT to make it as TIGHT as possible.

Plastic Surgery and Weight Loss

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If you’re hoping that plastic surgery will produce weight loss, you are wrong! What…? Are you kidding me, the title of this blog is plastic surgery and weight loss!!

Plastic surgery is NOT where you START your weight loss program. I CAN, however, help you get started and I can help you STAY on track with your weight loss either before or after your plastic procedure intervention!

I could simply take your money and do your tummy tuck or liposuction or breast reduction/lift and send you on your way only to have you bounce back to have more body contouring procedures. That would be great for my pocket book but it really wouldn’t help you at all.

My goal is to help you sustain a HEALTHIER LIFESTYLE through diet and activity intervention before and after your plastic surgery procedures. That is the ONLY way to keep the shape I give you and for you to keep the weight off!

Here are your FIRST most valuable tips to help you get started:

  1. Cut back on the Fruit — you’re pounding tons of fruit because everyone says it’s so healthy and this will help you lose weight. Many food and nutrition guides are now just starting to get the word out that most of the fruits you love are too high in fruit sugar content. Sugar is sugar. Berries are lower in sugar and of course more tart and most people don’t choose the strawberries, raspberries, blackberries and blueberries as their fruit of choice. You go straight for the watermelon, bananas, cantaloupe, and honeydew, etc. These fruit are very high in sugar content and will only stay your hunger for a short few hours and send you craving and starving for more food when your sugar levels plummet and your insulin is still scavenging through your body looking for more sugar. THIS ALSO APPLIES TO THE FRUIT/PROTEIN SMOOTHIES which tend to be too high in sugar.
  1. Cut back on the Carbohydrates — cut WAY back on all breads, pasta, cereal, oatmeal, and rice. It doesn’t mean you can’t have any, it means you shouldn’t have it with every meal or with every dinner. The portions also should be measured and STEP AWAY FROM THE TABLE when you are done eating. Do NOT get seconds.
  1. Increase your protein — protein in the form of fish, meat, and chicken/turkey. You may think that being a vegetarian is healthier and will reduce your fat and caloric intake but actually you may indeed be consuming not only more calories in your rice and grains but the wrong kind of calories in the form of carbohydrates. You need more protein. Protein will stay your hunger longer and level out your insulin levels and hence your blood sugar. This will help minimize the up and down cravings you may be currently suffering. This may also help your constant hunger you tend to feel when you try to “diet.”
  1. Snack on nuts and beef/turkey jerky—if you are a grazer and feel the need to crunch and eat between meals or if you don’t have time for a meal, choose nuts and the dried meat jerkys of your choice. This is also a good way to stay away from sweets or protein bars/snack bars, which tend to be high in carbohydrates.

More to come in next blog….On How to Stay Motivated on Your Weight Loss Journey…

REJUVENATION – Rick Stoff, Town & Style St. Louis

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Town & Style – St. Louis featured Dr. Koo in an article detailing ‘combo surgeries’ such as the Mommy Makeover and why they are growing in popularity. Here’s an excerpt from the article:

The appeal of cosmetic surgery probably increases with the number of candles blazing on your birthday cake. After blowing out the latest inferno—and viewing the celebratory pictures—many a celebrant will decide it’s time for some self-improvement. But where to start?

combo surgeries
Especially popular with young moms and the more matronly (or patronly) alike, combo surgeries are the proverbial two-fer. They may not exactly offer ‘two-for-one,’ but they do come with other attractive features. For one thing, you can tackle two related problem areas at the same time.

And there are indeed some cost- and time-cutting benefits. “Combining operations may allow for fewer down times and less time off work, so it is more cost-effective,” says Dr. Judith Gurley of Judith Gurley Plastic Surgery and Medical Spa.

“It saves recovery time and operating room and anesthesia costs,” adds Dr. Michele Koo. “Any combination of surgeries is possible. It depends upon what the patient requests and whether it makes sense and is safe. Often an insurance-covered procedure is combined with a cosmetic one.” …

have it your way
“There really isn’t a combination that cannot be done together,” says Koo. “The ‘makes sense’ part is the location of the surgery. Combination brow-lift, eye-lift and face-lift makes sense since I address the rejuvenation of the entire face. A complete face rejuvenation also can be performed with a breast lift or a breast augmentation.”

Combined facial procedures can bring enhanced outcomes, Gurley adds. “A combined approach can avoid the ‘operated on’ look. This involves maneuvers such as lasers for tightening, fat injections and fillers for plumping, and eyelid lifts for removing extra skin. These techniques can be done under anesthesia so there is no pain.”

Breast procedures are often scheduled with arm reductions or tummy tucks—the removal of excess fat and skin. “Breast reductions and tummy tucks are an excellent combination,” Koo says. “Breast reductions often are covered under insurance, along with an overnight hospital stay. The overnight stay can be used in conjunction with the tummy tuck, which is an elective procedure not covered by insurance.”

Read the full article at

Botox for Men

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There’s a reason why BOTOX has been given the nickname “BRO-TOX!”

Men love the quick fix for looking younger and better but not different. No downtime, no evidence, and most importantly it takes 5-15 in the doctor’s office.

So why wouldn’t you do that? Many men do receive BOTOX to smooth the lines across the forehead, the crows feet or the angry “11’s” between the eyebrow.

One caution is don’t go to a spa that has a different aesthetician inject each time and not see you in follow up in a few weeks to insure a consistent & reproducible result.

Another caution is not all Botox injections are the same. Make sure your (preferably) doctor does this frequently, and is using the true BOTOX product at the appropriate dilution.

Happy Bro-toxing!

Schedule a consultation to learn more about Botox!

Frustrated with Fat Tummy and Thighs?

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Tummy and Thigh Fat - St. Louis Plastic SurgeryMany of my patients become quite frustrated with the rolls of tummy fat and saddlebags after pregnancy. By the time they see me, a plastic surgeon, they are depressed, exasperated, and another 35 lbs overweight.

If you fall into the category of “look at my belly, nothing I do is going to change it, so I’m going to eat that cake for dessert,” then it’s time to drastically change your eating and exercise habits. It may even be time to see a plastic surgeon and ask what the options are for removing that skin, or at least thinning out your waist and thighs.

The key is not to fall into the despair mode and stop caring about yourself. That is a negative feedback loop of further frustration and weight gain. Break the cycle.

But HOW? Start with a few very simple tricks.

  1. DO NOT BUY THE FOODS YOU CAN’T RESIST – e.g., ice cream, cookies, potato chips, pastries, etc.  If they are not within reach and you can’t see them, then you won’t have to resist. You simply will not have them readily available.
  2. INCREASE YOUR PROTEIN – eggs, fish, meat, Greek yogurt.
  3. DO NOT SUBSTITUTE FRUIT for your sweets, sugar is sugar and fruit is full of sugar. The common mistake is to eat as much fruit as you would chips and cookies and wonder why you are not losing weight. Carbohydrates are sugar and fruit is still considered in my opinion in the carbohydrate category.
  4. SNACK ON LIGHTLY SALTED NUTS for your need to munch and snack. Nuts are very filling and will satisfy the nervous bored need to eat with a healthy nutritious snack.

Let’s start with the above and next we’ll go on to the activity level to get you started on a happier more self controlled lifestyle. Contact our office for more information!

Can Men Actually Have Breasts?

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The answer is yes and I know this is extremely embarrassing for both adolescent and adult men.

The male breast development may have started as a teenager when you may have been a little chubby. As you started to look around and notice other guys and become aware of young women, you became more and more self-conscience of your developing male breasts. You became more and more embarrassed and became less and less willing to participate in sports and activities hence worsening the weight gain and noticeable breasts.

As you then started a radical weight loss program and mission to weight lift and take supplements you noticed that you certainly became skinnier and more cut up but your breasts didn’t go away. You forgot about it or you started to take even more supplements.

This may not have been your exact scenario but there are parts of it that may resonate with you. Gynecomastia or the benign development of male breasts is extremely common and normal. Up to half of adolescent boys may develop some breast tissue. While 75% of gynecomastia will resolve within 2 or 3 years of onset, there more often than not is a residual hint of a “knot” of firm breast tissue that remains beneath the nipple areolar complex that simply never resolves.

This manifests as “prominent nipples” or “breasts” in tight shirts or when shirtless and is often a source of jokes, “man boobs”, etc. This firm tissue is actually true breast tissue and will NOT go away with any changes in weight and actually has to be removed with direct surgical excision rather than liposuction, which can remove the remainder of the excess fatty breast tissue.

I want you to know that you are not alone. We don’t know if the increasing hormone enriched foods we consume or other additives in our diet has increased the incidence of gynecomastia, but it does seem to me that I have seen more and more men of all ages wanting to have intervention for the removal of the excess breast tissue.

As long as your male development has been normal, you’re not on any medications or supplements that is causing or exacerbating the condition, and you do not have a medical condition that may be causing the gynecomastia, the majority of the gynecomastia will resolve as I mentioned in 2-3 years. During this time, you may even feel like your breasts feel more swollen and larger at times and may even be tender. If your gynecomastia does not resolve, a combination of direct surgical excision and liposuction will remedy the contour deformity that has plagued you since your teen years. The surgery is very safe and is performed in 1-3 hours as an outpatient procedure.

I want you to first know that the majority of cases of male breasts are benign. twenty-five percent may be from medications or some underlying medical condition, which should not be ignored. A simple history and physical should determine whether this is a likely cause. Male breast reductions are becoming more and more frequently performed and are safe!

MOMMY MAKEOVER…I’m sick of these saggy breasts and stretched tummy…

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What is a Mommy Makeover and can I possibly get my flat pre-baby tummy and perky breasts back? The answer is yes. You’ve had your baby(ies), you’ve lost as much weight as you can, but you now have saggy scooped breasts and tummy skin with all sorts of stretch marks, and a wicked alien looking belly button…HELP.

A St. Louis Mommy Makeover can consist of a tummy tuck, liposuction, breast lift, and breast augmentation or any combination of the above. You decide what bothers you the most or what you want to achieve. The breasts and tummy can be fixed all in one surgery.

A tummy tuck will repair your split abdominal muscles, remove all the stretch marks below and just above your belly button and can even give your upper thighs a lifted slimmer look. The breast lift will remove the excess skin and reposition your nipples so they look out from your chest and NOT DOWN at your toes. If you want to regain fullness and firmness, you will need a breast implant at the same time as the breast lift.

Take home message: do not despair! First, eat healthy and make time for at least 15 minutes of walking or exercise at least twice a week. Try to cut down on the carbs and portions and then consult a plastic surgeon of your choice who will really hear what you want. Someone who GETS IT.

Don’t be discouraged by your body. Stop your unhealthy eating habits now, before you gain more weight and are even more frustrated with your appearance. That extra skin and lax belly can all be fixed safely.

If you are interested in learning more about Mommy Makeover procedures and what combination of procedure will suit you best, schedule a consultation with Dr. Michele Koo!

I Really Want to Improve my Face… But Do I Need to Have Surgery?

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The answer is NO. I tell my patients to start simple. The thing many people forget about is their SKIN! The first thing one sees on your face is your skin quality, the texture, and pigmentation. Taking care of your skin with medical products that truly improve the cellular components will significantly improve the overall appearance of your face without spending beaucoup bucks!

All Skin Care Products are not the same and just because you buy it at a high-end department store does not guarantee that the products will be effective.

There are ingredients that will improve the fine wrinkles and are anti-aging but honestly they’re not available over the counter. Most of the truly effective products are by prescription or available through a medical office. The reason is that the concentration of the effective ingredients cannot be sold in over the counter makeup or skin products. These ingredients can sometimes damage and harm skin and must be monitored by a trained personnel. Unfortunately, you might have to pay an office visit but typically you should only have a ONE-time fee and can start your entire skin regimen that will put off surgery perhaps forever.

A few basic products you MUST have:

  1. Sun Block – look for products that are tinted for extra protection. A minimum SPF 30 is what you want for your face. The products I love the best don’t feel greasy, stay on and apply like a foundation. I often use a tinted sun block instead of any foundation at all and I use it absolutely everyday!
  2. Face Wash – look for a wash that is free of the sulfates and sulfites that can be skin irritating and one that is specific for your skin type and needs. If you want anti-aging, anti-wrinkle results, look for lactic acid, trichloro-acetic acid, phytic acid, ascorbic, and perhaps even some estrogen. There are ingredients for every type of skin need from acne to pigment.
  3. Moisturizer – even if your skin is oily, you need moisture. Many of my patients wash their skin with such harsh ingredients to control the oil and acne that they actually cause their skin to produce MORE oil and create more breakouts.

Again, all of your Skin Care products should contain the ingredients targeted specifically for your skin needs. That is the most effective way to have get the most out of your dollars spent rejuvenating your face. You may buy products from the drug and grocery store, and online, but the key is to have an experienced trained medical personnel diagnose yours skin’s needs and address those needs with the best products available. Sometimes the filler ingredients (non active ingredients) can irritate your skin and care should be taken that your products are not working against each other.

MORE TO FOLLOW… In the meantime, if you have any questions or would like to discuss your St. Louis Skin Care needs with Dr. Koo, Schedule a Consultation today!

How Often Will I Need to Change My Breast Implants…and WHY?

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One of the first questions my patients ask when considering a breast augmentation in St. Louis is how long will my breast implants last? When I tell them the breast enhancement using breast implants, whether saline or silicone implants will NOT be a ONE and DONE surgery, they are disappointed and worried about future costs.

Let’s go over why your breast implants will need to be replaced.

First, your breasts will continue to change with age, especially if you gain, lose weight, or become pregnant. Even if you don’t breast feed, your breasts will change with pregnancy! Your breast may become saggy and you may lose more breast volume. When this happens your skin will “slide off” the breast implants and your breasts will appear to have fullness on top with the rest of the breast and nipple at a lower position.

If this happens, you can change the size of the implant to create the size of breast you desire and remove any excess skin to reposition the nipple into a “perky” position.

Second, the breast implant has a lifespan of 10-20 years. Saline implants may begin to lose volume at 10-15 years or may appear to “ripple” if you have very little breast tissue of your own overlying the saline breast implant. After 10 years, your breasts may also become more firm and eventually actually feel hard and become misshapen. This is also an indication you will need an implant replacement.  Some patients keep the same silicone implants for more than 20-25 years without a problem.

Typically, the breasts will become firm and change shape after 10-20 years. When this happens you will need to remove the implants, the existing scar capsule, and any excess skin. You may or may not wish to have the implants replaced. Most of my patients do want to retain full breasts and opt to have new implants.

The initial surgery as well as the subsequent replacement surgeries are very safe and are performed as an outpatient with a minor recovery.

If you would like to learn more about a breast augmentation in St. Louis, schedule a consultation with Dr. Koo today!

What is Botox?

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Botox! Yikes, isn’t that a very deadly poison? The answer is no. That would be Botulism, a serious and life-threatening illness. But they come from the same source: Botulinum toxin.

Botulinum toxin is a protein and neuro-toxin produced by a bacterium called Clostridium botulinum. It can cause botulism, a deadly disease. Another form of it, with the popular trade name Botox, is what is used today for cosmetic purposes.

Justinus Kerner, a 19th century German poet and medical writer called Clostridium botulinum the “sausage bacteria” because it was found on improperly handled or prepared meat and sausage. It was in 1895 that Emile P. Van Ermengem isolated the microbe and discovered that it produced a toxin from a piece of ham that had poisoned 34 people.

The modern therapeutic form of Botox (BTX-A) was used by Professor Edward Schanks who began working with the bacterium in 1944 while working for the US Army at Fort Detrick, Maryland investigating germ warfare. In the 1960′s, ophthalmologist Alan Scott collaborated with Schantz and by 1973 began injecting it into monkeys. In 1978 he got government approval to inject it into humans.

The secret to Botox is that it causes the controlled weakening of the muscles near the injection site. Results of the treatment can be seen within 3-4 days with the peak effect at 10-14 days. The effects last for four to six months, and must then be repeated.

In 1988, the company Allergen bought the rights to sell BTX-A (Oculinum, as it was called) and shortly after received approval to use it for crossed-eyes and facial spasms. In the early 1990′s, Canadian Ophthalmologists Jean Carruthers was using it on patients to relieve eyelid spasms and noticed that some of the patients were losing their frown lines. She and her husband published a study in a medical journal reporting that though temporary treatment with Botox was a safe and simple procedure for reducing brow wrinkles. Cosmetic surgeons and other practitioners took notice. By 1997, it’s use took off.

In April 2002, the FDA approved Botox for use in reducing frown lines between the eyebrows. Botox is an incredibly useful tool for reducing wrinkles for forehead, crow’s feet, and between the eyes. It can also be used on smoker’s wrinkles and the chin. Botox can help make the eyes much more attractive. It has also been useful for the treatment of muscle pain and is now commonly used to treat migraine headaches.

To repeat, Botox treatments are safe and delay the signs of aging. At the end of 2006, the sales of this treatment passed one billion dollars with over half for cosmetic purposes. As of 2007 Botox injection is the most common cosmetic operation.

New Trends in Plastic Surgery – When First Impressions Count

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Often times, a person decides to undergo some form of plastic surgery to boost their self-esteem and enhance their self-image. But new studies based out of New York City boasts that plastic surgery can actually boost a person’s chance of gaining employment.

Surgical procedures such as chin augmentations can create a favorable impression on the general public. It seems as though strong jaw lines and chins are linked to trustworthiness, dependability, and other positive and desirable characteristics in the workplace. People subconsciously associate a stronger chin with more authority, self-confidence, and trustworthiness. Therefore, chin augmentations are among the newest trends in plastic surgery.

Professionals, both men and women over the age of 40, seem to crave that strong jaw line that they feel will give them the upper hand in the workplace and are turning the plastic surgery procedure of chin augmentation to achieve it. This three hour plastic surgery procedure, which has been coined “the chinplant,” has become popular among Americans and has increased in the US roughly 71% in the last two years. One of the highest rates of increase is seen in women in corporate America.  Could it be that this sudden urge for plastic surgery could be linked to the everyday use of video conferencing in the business world? Business executives often find themselves “face to face” with people of important statuses from all over the world via video conferencing. It is these interactions that have people thinking of their appearance and how important that first impression can be.  A promotion, an added responsibility, a significant contact can be made all based on the impact of a person’s appearance.  Therefore, the desire to use plastic surgery to enhance their looks seems to be a possible way to also enhance their resume.

Plastic surgery is undoubtedly a booming business, with chin implants gaining popularity in competitive work environments because of their seemingly enchanting ability to give an edge to the willing recipient.  Whether this is a real or perceived notion, it seems as though the “chinplant” will continue to be among one of the leading trends in plastic surgery.

Does it help to have ideal result photos during a rhinoplasty consultation?

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A very common question when considering rhinoplasty is whether example photos help during the consultation process. Pictures to illustrate a desired result can help a board certified plastic surgeon to understand patient expectations and a desired result.

Most patients considering plastic surgery have an excellent idea as to what changes they want to see as a result of their rhinoplasty procedure and pictures help to give a plastic surgeon a visual representation of these changes.

There are some things that should be considered when bringing photos to a plastic surgeon during a rhinoplasty consultation.  Consultations and examinations should be an open process where patients feel comfortable sharing their goals and expectations. But patients should also be open to discussion since no tall results are possible given the underlying structure of the nose. During a rhinoplasty consultation, a board certified plastic surgeon may suggest the image example isn’t realistic because of the patient’s facial structure.

It is easy to idealize a photo and the structures possessed by celebrities, but it is important to note that photos of celebrities are often best case scenarios and may not actually work for a patient’s personal facial balance.  Photos of celebrities are often “touched up”or edited to make celebrities look their very best.  The final result is a photo of a perfectly shaped nose that may not be possible given the limitations of a rhinoplasty procedure. Tricky camera angles and lighting can obscure the real structure of the nose. Board certified plastic surgeons often prefer photos of family members as their facial structure and nose can be very similar and make the desired results much more likely.

It is also important to note that not all rhinoplasty procedures fit all facial shapes and contours.  In most cases, an idealized nasal shape and size can simply mean facial balance and harmony.  One nose does not fit all.  What looks good on someone else may not look good on you.

Rhinoplasty is a highly personalized procedure and a consultation should be seen in that light. While photos provide excellent examples for a board certified plastic surgeon to gain further understanding in the overall outcome of a rhinoplasty, there may be issues with the photo that make the results impossible or improbable to achieve. A rhinoplasty consultation should be an open conversation between patients and surgeons and this will increase the patient satisfaction following a rhinoplasty.

Plastic Surgery Popularity Growing Among Men

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Let’s be honest, plastic surgery has always had a stigma attached to it. While good plastic surgery often goes unnoticed, the horror stories often create and attach a negative stigma. As more positive results have been publicized in Hollywood and among social circles, plastic surgery is growing rapidly in popularity among women.

As plastic surgery has become more socially acceptable for women, men have often looked the other way and never considered having plastic surgery for themselves. Since men have largely avoided going under the knife, the procedures and techniques that have been developed over the years have largely favored women. A sit did with women over the years, plastic surgery is now growing in popularity among men, and plastic surgeons are beginning to create more effective ways to rejuvenate and refresh the appearance of their male patients.

According to a recent report in the L.A. Times, more than twice as many men are choosing plastic surgery now, compared to just 15 years ago. While men still make up less than 10% of all patients in plastic surgery, this is a positive sign that men are beginning to ignore any negative stigmas that may have prevented them from undergoing procedures in the past.

While it is difficult to show what has changed the social perception of plastic surgery among men, it is clear that more men in Hollywood are choosing to have surgery to appear younger and more refreshed.  With Botox leading the way, a term was recently used on Nightline ABC to characterize the procedure done on men.  They dubbed it… “Brotox”. While many of the procedures performed on men are less-invasive like Blepharoplasty (eyelid surgery) or “Brotox,” some men are choosing to appear more youthful with a facelift or tummy tuck. While women still hold the title for most likely to undergo plastic surgery, this recent shift has shown that men are making a move toward appearing more youthful and refreshed with the help of plastic surgery.

Can Breast Implants Give Me Fuller, Natural-Looking, and Shapely Breasts?

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You may want fuller breasts but may be asking yourself, is it possible to have breast implants that fit your body?  Is it possible for breast implants to look natural and shapely as well as make your breasts larger?

Breast enhancement with saline or silicone breast implants is very safe. Both types of breast implants are FDA approved for elective breast augmentation.

While general anesthesia is required, the surgery itself should only take 30-45 minutes. You can drive the next day and return to routine daily activities. It will take two weeks before you are able to exercise.

The most common questions I am asked by my patients is, can you make my breasts look natural, still sloped, and “tear drop” shaped? Can you make them proportionate to my body? Will people be able to tell I have breast implants?

Yes, people will be able to tell if you have breast implants because they will be too perfect to be real. If you are over the age of 23 and have had children and your breasts are perfect, people will guess that they are not real but they will never know for sure until you tell them.That’s how real breast augmentations can look and feel.

As far as the look of the breast, the majority of my patients most want beautifully shaped breasts, with size as a secondary priority. Shapely, beautiful but still tear dropped and sloped.If you want to hide them, you will be able to by wearing looser clothes. If you want to show them, you can wear tighter clothes and use a push up bra.

Yes, all your goals can be met, but it is up to you to convey those wishes and to make sure your plastic surgeon understands what you want.Bring breast photographs you like to your consultation and make sure your surgeon understands the look you want to achieve. It is also important that your surgeon is very honest with you and educates you as to what can be achieved given your starting breast anatomy.

I believe that your “perfect” breast enhancement can be achieved. It’s a matter of communicating with your plastic surgeon and seeing her previous results of similar breasts. Most importantly, breast augmentation with breast implants is very safe and considered relatively non-invasive! Go achieve your “perfect” breasts!

I’ve Seen Videos of Liposuction…it Really Looks Painful and Scares Me…Is That Truth or Myth?

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The videos you’ve seen of liposuction are probably all real and do in fact look pretty brutal. However, you should know that liposuction recovery is actually very minimal and NOT very painful. Could you call it completely non-invasive?

I wouldn’t go quite that far because the type of liposuction that really works requires the fat to be removed. For fat to be removed you have to have surgery, and for safe surgery you should be in an operating room. For complete removal of a significant amount of fat you probably should have general anesthesia.

General anesthesia under a controlled operating room setting performed by an anesthetist or anesthesiologist is extremely safe and preferred. I feel I have complete control of the operating situation and can do what I need to do to give the most complete and best results possible. I never compromise  my patient’s safety or well-being. I am therefore blatantly honest with what is required and will tell you what you NEED to hear, not what you may WANT to hear.

If you want to hear that you can have liposuction during your lunch hour under local anesthesia or have an external device applied to your skin and walk away inches smaller with no cellulite, FORGET IT. Those are gimmicks that will waste your hard earned money. If you want something meaningful done that will change your shape, get the appropriate surgery or don’t do anything at all.

I will tell you though that ultrasonic liposuction, whether you want to call it VASER LIPOSUCTION, TUMESCENT LIPOSUCTION, ULTRASONIC LIPOSUCTION, all work. You just have to be careful what your surgeon means when they are using these terms.

If you want true results that removes the fat, you will need the application of cannulas under your skin to physically remove the fat. The recovery is amazingly short with very little pain depending completely on the VOLUME that is removed. The more volume of fat removed, the more the recovery. Don’t let any doctor tell you otherwise no matter how much you want that one-hour liposuction. Get the right liposuction procedure for you and that procedure depends on what you want to achieve.  Don’t be afraid of how invasive liposuction is because it really can have very little downtime and pain.

Do You Want Nice, Smooth Skin With Fewer Wrinkles and Less Pigmentation?

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You would be surprised how little you have to do to get smoother and livelier looking skin. However, it does require maintenance. The only maintenance required  is daily skin products and a little bit of intervention.

I formulate medical pharmaceutical grade products with my pharmacist that will be less expensive than the unproductive, over-the-counter products you spend a fortune purchasing.

Yes, of course, you should stop smoking and protect your skin from the sun. I even have pharmaceutical grade sunblock that is specially formulated. All those skin products you spend a fortune purchasing that clutter up your entire bathroom can’t compare to using as few as three of my specially formulated products designed for your problem and skin type.

These formulated products can often be covered by insurance.  In combination with an office peel, BOTOX or filler, such as Juvederm these products can make your skin look years younger with less discoloration and wrinkles. You would be shocked at how little the costs are compared to what you currently spend. The key is to use the appropriate products for your skin and that the products are doing what they actually say they should be doing. But how would you know? You see the ads, you read the back of the bottles and jars, and you listen to your friends.

The truth is none of the over-the-counter products will change your skin at the cell level to generate new collagen or get rid of the brown spots. None of the products that work can be sold over the counter. You need prescription strength products to achieve the desired changes.

The key is to have your skin medically evaluated and have the products tailored to your needs. It is important that the person evaluating your skin truly knows the science and the medicine behind skin and the products necessary to make the changes. I love seeing my patients transform their skin over a period as short as three months!

Why Do I Have Flattened, Stretched Out Breasts After My Pregnancy…and What can I can do about it?

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These are very common questions women ask during a consultation for breast rejuvenation. Everyone thinks breast implants are only to make breasts bigger. This is only one aspect of what breast rejuvenation can achieve with a mastopexy (breast lift) and breast augmentation.

Silicone or saline breast implants can reshape breasts and also make them more symmetric. After pregnancy, weight gain and loss, breasts can appear deflated, stretched, and elongated.

A breast lift with a breast enhancement can completely reshape the breast. The nipple is lifted to the center of the breast mound and the breast implant fills the deflated skin envelope, recreating the volume of a very natural sexy looking breast.Asymmetry of the breasts can be almost completely corrected and the enlarged areola can also be reduced. The breasts can regain a soft, very natural looks natural as with with the rest of the body.

One does not have to live with the unpleasant results of aging or pregnancy. The saggy, flat breasts that make you feel unsexy, with NO desire to wear a swimsuit or be seen naked can safely be remedied.

The surgery requires about 1½ hours of general anesthesia but the recovery is very quick. You are able to drive the next day and can do simple household chores, perform office duties, and take care of your children in approximately two days. Returning to light exercise will take about two weeks, and four weeks for strenuous boot camp work outs.

Breast enhancement and rejuvenation is all about achieving natural beautiful breast shape and is safe and very achievable!! It’s not just about the size but it is about YOU liking yourself and the way you look!

Schedule a consultation today with Dr. Michele Koo.

Why do women get breast implants?

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This may seem like a very obvious question with a very obvious answer… to get bigger breasts. But it is actually a much deeper and more meaningful question than you might suspect.

The answer also depends on your age and if you are male or female. Let’s start with a woman in her 20′s, pre-children and perhaps pre-significant other. While women who seek breast enhancement and breast implants obviously want to have larger breasts, you might be surprised to know the majority of women are doing this for themselves only because they want to feel more confident and have a balanced body. It is about feeling more comfortable and confident in one’s own body. It isn’t to seek attention for one’s breasts or to flaunt their sexuality (those aren’t bad either,but truly not the primary motive).

As a female plastic surgeon, I truly understand the female body image that runs through a woman’s head starting at a very young age. We seek beauty and balance. We are vain but don’t want to be thought of as vain. We can’t increase the length of our legs (which is what we truly want) so this is the next best thing!

The next group of women are post children, breasts are a little saggy, skin that has some stretch marks, with absolute loss of volume(the breasts may even look like the old Playboy’s cartoon caricatures of grandma’s with extra long bananas for breasts). These women hate their breasts and do not want to be seen naked or in a swimsuit. They feel their breasts are ugly and therefore the rest of their body is ugly. These women don’t want to go out, don’t enjoy shopping for clothes, and don’t feel motivated to eat healthy and stay fit. Can all this result from just your breasts?? Well, yeah, of course! Any woman who has had a really bad hair and skin day will tell you that they don’t want to be seen that day, they don’t feel good about themselves that day, they tend to over eat and subsequently feel worse that day, and they can’t find anything to wear that looks good that day. Just think if this feeling lasted more than just a day, and you had to look at what you felt were awful breasts everyday! A breast lift and a breast augmentation,repositioning the breasts to the chest with volume does wonders for a woman’s outlook and self confidence.

I have learned from my patients and from my own insecurities growing up that my self confidence or “happiness” is often tied into my perception of how good or bad I look. While this may seem very shallow,it really isn’t. Our outside appearance is a projection of our inner self. If we are tidy, “put together”, and well groomed externally, we feel more at peace and there is balance and harmony in our mind and life. If our appearance is disheveled, disorganized and dirty, this is a projection of the chaos within. We feel ”out of control.” Our outward appearance tells the world whether we care about ourselves or not. In my opinion, the women who seek breast enhancement, care about themselves and their appearance and want to take charge of their lives and make the best impression possible with balance, harmony and beauty. And truly we need to be the first person to care about ourselves if we want others to care about us.

These are all good reasons to go forward with any cosmetic surgery… that we care about ourselves. No, this isn’t the most important thing in life and may seem so trivial and superficial to many, but it is about being the best you can be. Life is short and we should go after what it is that makes us more productive, happy, and confident. We can’t change the world all at once but we can start by making ourselves happier and hopefully more productive, thereby starting the ripple that may become a tsunami.

You’ve been considering a breast augmentation ever since you can remember

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While visiting with women considering breast implants in my St. Louis plastic surgery office, I often hear the same concerns. While it’s impossible to get medical advice on the internet, I wanted to share just a few things for you to think about before taking the next step.

  1.  You don’t know how to choose your surgeon
  2. You don’t know if the surgeon will understand exactly what it is you want and if she/he can create what you have in your mind
  3. You don’t know if you want a saline or silicone breast implant
  4. You don’t know if you want the implant under your breast or under the muscle
  5. You are not sure if you need to have a breast lift along with the breast implant.

All of the above questions are completely legitimate. I’m going to give you a list of questions you need answered by your plastic surgeon. You also need to educate yourself on the look and size of your future breasts. You therefore need to acquire a breast vocabulary. You will then be able to ask more informed questions and you will know how to better describe exactly what it is you want your breasts to look like.

  1. The first question you need answered is: Is your plastic surgeon a BOARD CERTIFIED PLASTIC SURGEON?
  2. Is your plastic surgeon a Member of the Aesthetic Surgery Society?
  3. Does she/he have MANY before and after pictures of women who have had breast enhancement and are those patients willing to talk to you?
  4. Have your plastic surgeon explain the positives and negatives to silicone versus saline breast implants.
  5. Do you know how often you will need to have your breast implants changed?
  6. What about future mammograms?
  7. What if you have a family history of breast cancer?
  8. How full will my breasts be and how long will that look last?

The remainder of the questions are actually thoughts you need to sort out before finalizing your decision as to the ‘CUP SIZE’ of your augmented breasts.

  1. How noticeable do you want your breasts to be? Do you want them noticeable all the time or do you only want them noticeable when YOU want them to be noticed (when you wear something tight, are naked, or in a swimsuit)?
  2. How round and full do you want your breasts to appear? Do you want them to fall gently off your chest wall and want a very natural slope so your breasts almost appear to be a little low so no one will guess you have breast implants?
  3. If your plastic surgeon were to err on a fuller side or a smaller side for your breasts, which would you choose, fuller or slightly a little smaller?

Truthfully, the most important point is that you convey accurately what you want your breasts to look like. Your surgeon should completely understand your vision for your body. She/he should be able to articulate back to you exactly what you feel you want for your breasts. You should view before and after pictures from your prospective plastic surgeon’s photo gallery. You need to bring a picture of your “perfect breasts” to your plastic surgeon so she/he can see your mind’s eye view of what you want AND of what you don’t want.

You need to be completely comfortable with your surgeon and truly feel that you have connected. I think that is THE most important element of achieving your perfect breasts. Your breast enhancement surgery should be seamless and a great life enhancing experience. If you do your homework and ask the appropriate questions, you’ll be thrilled! Let me know how it goes and feel free to contact me with questions. I’d be more than happy to help you out and answer your questions of concern.

Do something for yourself and make yourself feel better

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So you’re thinking about plastic surgery for those stubborn areas of fat, flat chest, or excess left over baby skin… First of all, I want you to know plastic surgery procedures are safe. Second, stop feeling guilty and start taking care of yourself. You’re so busy running around doing things for your kids and husband, you forget about yourself and you feel guilty if you even buy yourself a little lipstick.

I know, I get it. As women, we are brought up to do for others first, especially for our children, husbands and family members.I go through the same daily stresses as you, perhaps with a little variation: my Mother who I am extremely close to is very sick, I’m passionately devoted and feel very obligated to making my patients happy, I have teenagers, two of which are girls, and a very busy husband. Need I say more?

We all go through the daily grind of the bleary sand in the eyes when you wake up feeling like you’re so tired you can’t get through the day. The feeling of being so overwhelmed you have chest pain. But, we do it everyday and we get through the obstacles and we move on. I want you to know we are all in it together. It is OK to do something for yourself. Really it is.

You don’t have to go straight to plastic surgery, but you should start with something that makes you feel healthier. Take an exercise class. Sign up for the class on a regular basis; pay for it upfront and lock yourself in so you can’t make excuses. You’ll be amazed how much better you feel with a little regular sweating and exercise. As you continue to this, you’ll actually see results which will motivate you to go to the next step.

Choose your foods more wisely. Carbohydrates are NOT your friend. Even eating a lot of fruit is NOT healthy. Lightly salted nuts or raw nuts are the best solutions to satisfy the need to munch. You don’t need crazy diets, you need to choose your foods wisely and step AWAY from food when you are NOT hungry. Keep in mind, my philosophy is that I am here for YOU. I want to make your life better by empowering YOU. Whether you choose to have a breast augmentation, liposuction, or tummy tuck is not the point. It is about making you feel better about yourself so you will take better care of yourself and ultimately be better for those around you. 

I will not suggest anything for you that I wouldn’t do myself. I ONLY suggest the minimal intervention necessary to achieve the great natural look. I DON’T want you to look “DONE.” I will also steer you away from anything that is dangerous and not in your best interest, no matter how much you ask for it.

Begin today, TAKE CARE OF YOURSELF AND FEEL BETTER AND MORE CONFIDENT… and go buy that lipstick!

Are Breast Implants Stupid? Why Augment Your Breasts…?

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You may think using breast implants to enhance a woman’s breasts are ridiculous and fake… but ask any woman who has had her breasts enhanced and you’ll get quite a different answer.

Nearly all women have their breasts enlarged for themselves. They want to feel that their breasts and body are in proportion. They want to feel balanced, be able to wear a swim suit, feel less self conscious, and to feel sexier in and out of clothes. Truthfully they just want to feel a better about their own body.

Is that wrong? The public condemns woman seeking breast augmentation and implants

as being vain, vapid, and “slutty” for the reason of wanting attention for themselves in an unbecoming manner. Really, that couldn’t be further from the truth.

Woman want to be more comfortable with their own bodies. They want to feel comfortable being seen naked. If they don’t like how they look naked, they will never want to be seen naked or in any type of clothing that shows anything!

Breast implants are safe and the surgery itself takes less than an hour with 1-2 days recovery time. Yes, there is maintenance since the implants will need to be replaced in 10-20 years and mammograms may be more difficult. However, it is minimal maintenance and your plastic surgeon should see you every year after you have your breast augmentation as a courtesy for you.

What do you think, let me know your opinion. My opinion? Brest augmentation is very safe and very uplifting for any woman who hates what nature gave them. Don’t let nature own you, go out and take control!!

Liposuction what is the “skinny”, non-invasive vs invasive?

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High intensity external ultrasound liposuction, laser liposuction, external sound waves, smart lipo… what next? We’ve seen the demise of Lipodissolve because it simply didn’t work. Or I should say the results were minimal, with prolonged discomfort and swelling. Everyone truly is looking for the quick fix, but my question to you is, what in life worth having is without some amount of work or payment?

If you want something fixed you have to approach the problem with the right tools. You can’t tie your plastic surgeons hands, take away their tool box and expect the outcome you are seeking.
According to an article by Jennifer Capra and Peter Rubin in the latest PRS Journal, July 2011, noninvasive liposuction still has a long way to go. The following article is available through the ASPS free public access.

“Will liposuction become obsolete? Fueled by the success of effective minimally invasive and noninvasive treatments for aesthetic management of the face, the quest for effective nonsurgical body contouring technology continues at a robust pace. To date, no noninvasive body contouring treatment has assumed a prominent role in plastic surgery practice. Jewell et al. present data from a randomized controlled trial to demonstrate the efficacy of a high-intensity focused ultrasound device for reducing subcutaneous fat deposits. This study is a thorough investigation of the LipoSonix high-intensity focused ultrasound technology (Medicis Technologies Corp., Scottsdale, Ariz.), demonstrating both safety and efficacy in a blinded prospective trial. The authors are to be commended for collecting well-controlled data to test the effect of this device.

According to the 2010 report of plastic surgery statistics from the American Society of Plastic Surgeons, the number of patients seeking cosmetic minimally invasive procedures has increased from 5,500,446 in 2000 to 11,561,449 in 2010.1 This 110 percent increase is indicative of patients seeking the “quick fix” that allows them to improve areas of concern with decreased downtime and minimal risk. At 203,106 cases, liposuction is still one of the top five cosmetic surgical procedures performed in 2010, and while it is touted as “minimally invasive,” many technologies have been explored in an effort to improve body contour and tighten skin with less recovery and risk.

In Jewell et al.’s article, we see data from a multicenter, randomized, sham-controlled, single-blinded trial of 180 patients designed to determine the effectiveness of high-intensity focused ultrasound on trunk aesthetics. The primary outcome measure was reduction in waist circumference at 12 weeks. In patients treated at the highest energy level (59 J/cm2) in the “per protocol” group, in which maximal effect was seen, there was a statistically significant decrease in waist circumference of 2.52 cm compared with a decrease in the sham control group of 1.21 cm. One potential source of error in this study is the use of a standard measuring tape to determine waist circumference.2 Other modalities, such as three-dimensional photography or magnetic resonance imaging assessment, may be considered for future studies.3 In particular, magnetic resonance imaging will show precise changes in the thickness of the abdominal subcutaneous tissues after treatment. A major challenge in the evaluation of noninvasive body contouring treatments is establishing standard methods of assessment that can provide accurate and reproducible results. One other variable that may affect the results presented in this article is that the patients in this study population did not respond as well as other patients might have. Indeed, a prior high-intensity focused ultrasound study of 282 patients by Fatemi, one of the current authors, revealed an average circumference reduction in the abdomen and waist of 4 to 5 cm.4

While effective, the change in waist circumference induced by high-intensity focused ultrasound is relatively small compared with that in the sham-treated patients. This leads to two important questions. First, why does the sham group have a waist reduction of 1.21 cm? Second, how does high-intensity focused ultrasound fit into our aesthetic armamentarium?

With regard to the changes in the sham group, the authors stated that patients agreed to maintain their current diet and exercise regimens without any changes during the study period. In their Discussion, the authors do suggest that this decrease in waist circumference in control subjects may be related to unintended consequences of asking patients to pay attention to their diet and exercise habits. Despite our best efforts in asking our patients to comply with requests not to change their lifestyle, the placebo effect may be strong enough to induce subconscious changes in activity that favor tightening of the trunk muscles. It may have become a self-fulfilling prophecy that our patients, once treated with a device intended to improve their waistline, will adjust their lifestyle in accordance with the image they desire. Although it is impossible to regulate a patient’s lifestyle changes during a study period of 12 weeks, a diary of diet and exercise habits implemented both before and after treatment might have provided some insights into the changes seen in the sham group.

How high-intensity focused ultrasound fits into our aesthetic practice depends on whether patients will consider that it is worthwhile to undergo a safe 45-minute office treatment, followed by 7 to 10 days of mild discomfort and up to 16 days of edema and bruising, to achieve a decrease in waist circumference of a little more than a centimeter. The authors performed a patient satisfaction survey at week 12 that revealed interesting points. In evaluating the change in abdominal contour in the group that received the higher-energy LipoSonix treatment, 68.4 percent rated an improved or much improved score, compared with 23.4 percent of the sham group subjects. Clearly, patients within the treatment group noticed a change, but only 50 percent of this treatment group reported being satisfied with the results. Although not evaluated in this study, it is possible that repeated treatment with this device may lead to further improvement.

This technology, in its current form, will not make liposuction obsolete. It may, however, meet the demands of well-selected patients seeking less invasive procedures that can help with their “trouble spots.” Rather than take away from the pool of patients undergoing liposuction, this technology may bring a new group of patients to the plastic surgeon’s office who would not ordinarily have presented for evaluation and treatment. Because many patients presenting with a request for high-intensity focused ultrasound may be candidates for liposuction (even after their initial ultrasound treatment), it is imperative that board-certified plastic surgeons embrace noninvasive body contouring technology. Most assuredly, noncore aesthetic practitioners will be interested in this technology and may use this as a gateway to offering more invasive body contouring procedures.”