I'm afraid of anesthesia...is the "awake" method good for me?

by Robert N. Young, M.D.

Board Certified Plastic Surgeon

We've seen a new trend in Cosmetic Plastic Surgery...promotions of "Awake Breast Augmentations".  It is talked about as something new, but in actuality, surgeries performed under "local anesthesia", or "twilight anesthesia" have been around for many years.  Whether it is a good choice for patients is being hotly debated.

Because Breast Augmentation has become such a popular procedure, and is more readily talked about by society, some feel it has become somewhat frivolized.  It is easy to forget that this is still a major surgical procedure. While endoscopic (minimal incision) techniques have made the surgery less invasive and easier to recover from, the procedure is best done under general anesthesia with a Board Certified Anesthesiologist. "Twilight anesthesia" can be dangerous without an anesthesiologist present.

There is quite a bit of debate recently about practitioners who are advertising "awake" surgeries.  These are usually performed by physicians who are not Board Certified Plastic Surgeons, and may not even be Plastic Surgeons at all.  Sometimes they are Dermatologists, General Surgeons, or even Family Practitioners who elect to perform the surgery under local anesthesia because they do not have  privileges in a hospital or certified surgery center to perform those procedures. In my Surgery Center, all anesthesia is administered and monitored by Board Certified Anesthesiologists who are experienced in Cosmetic Plastic Surgery.  I feel this is best for my patients, and myself, as it allows me to concentrate on my area of expertise, which is the surgery itself.

My Surgery Center is fully certified by the AAAASF and meets strict standards to perform surgical procedures. Sure, the surgery costs a little more, but it is worth having the extra standards and safety factors. That's why doctors are credentialed and surgery centers are certified. If we didn't adhere to these standards we would be cheaper also. So when you get a fee quote that is cheaper because it is under local anesthesia in an office back room, be careful of what you are asking for.

Board certification by an ABMS member board provides assurance of a physician’s expertise in a particular specialty and/or subspecialty of practice. Professional organizations, such as the American Society of Plastic Surgeons (ASPS), the American Society for Aesthetic Plastic Surgery (ASAPS) require that members be Board Certified within their specialty.

Some advertisements even go so far as to state that you'll be awake enough during your procedure to pick the size of your breast implants (this would only be possible with saline implants which are inserted and then filled to the desired size) during your surgical procedure itself!  If you have had sedation you are going to feel woozy and wobbly.  I don't think you would be coherent enough to make this selection during surgery!

We recommend that you ask questions that will ensure that you are well informed concerning the qualifications and experience of your surgeon and the types of anesthesia that you are offered.  Here are questions generally recommended:

• Are you Board Certified? 
• If so, what specialty board?
• Are you licensed to practice surgery in this state?
• How many breast augmentation surgeries do you perform each year?
• How many years have you performed breast implant procedures?
• Where is my procedure performed?  
• Is the surgical facility accredited?
  
• Who administers anesthesia during my surgery?
• Is the person who administers my anesthesia Board Certified in this specialty? 
  
• What are my options for anesthesia?
  

When you come in for a consultation visit with me, I will make recommendations based on my extensive experience as first a reconstructive and then cosmetic plastic surgeon. I invite you to ask questions regarding various surgical methods, anesthesia, recovery and any other questions you may have so that you can make an informed decision about your surgery.  You may contact my office at 210-496-BODY (496-2639) or e-mail me at nubody@dr-youngforever.com.

How do I get started?

We receive many e-mails.  As you might imagine, some are routine inquiries about cost of Cosmetic Plastic Surgery procedures or how long one would need to take off of work.  At other times, however, we receive really great questions.  We'd like to share these, and we will publish ones we feel that our patients and friends will benefit from. To get things started, we'll share a very common one.

This was an e-mail received from Andrea in September 2009:

"Hello. I am very interested in getting my breasts done.  I've heard good things about Dr. Young and have seen many women who've had their procedure done by him.  How do I begin the process?"

We always encourage you to schedule a consultation visit with Dr. Young so that he has an opportunity to examine you answer questions you have, and make recommendations.  There are things you can do ahead of time to ensure that your consultation visit is as helpful to you as possible.

I always recommend that you make a list of all your questions.  And, add to the list as you think of other concerns or questions...no matter how silly they may seem.  Some information you'll be able to obtain from quality internet sites.  I prefer to lean towards information sites rather than "locate-a-doctor" referral sites. Information sites include plastic surgery association sites, implant manufacturer sites, and encyclopedia style sites such as:

American Society of Plastic Surgeons
http://www.plasticsurgery.org/

The American Society for Aesthetic Plastic Surgery

http://www.surgery.org/

Good encyclopedia style sites include:  howstuffworks.com, webmd.com, wikipedia.org, medicinenet.com, ezinearticles.com, and ehow.com.  You can look up your specific interests and learn about the procedures. Here are some sample links that would be helpful for Breast Augmentation research:

http://health.howstuffworks.com/breast-implant.htm/printable

http://www.plasticsurgery.org/Patients_and_Consumers/Procedures/Cosmetic_Procedures/Breast_Augmentation.html

http://www.implantinfo.com/

http://www.loveyourlook.com/

http://www.webmd.com/skin-beauty/cosmetic-procedures-breast-augmentation

http://en.wikipedia.org/wiki/Breast_implant

http://www.medicinenet.com/breast_augmentation/article.htm

http://ezinearticles.com/?Various-Views-on-Breast-Augmentation&id=3212987

http://www.ehow.com/about_5402302_breast-augmentation-information.html

Once you've had a chance to read through the information you'll undoubtedly have questions in how this information relates to YOU!  This is what is especially helpful in a consultation visit with Dr. Young.  There are many choices then it comes to surgical procedures.  An experienced, qualified surgeon like Dr. Young can help you make choices that are most appropriate for YOU, and not just what is popular at the moment.  (It is widely recommended that you seek out an experienced surgeon who is a Board Certified Plastic Surgeon, as they are physicians who have undergone years of additional training in this specialty.  They must pass strict criteria once completing this training, as well as show documented experience to demonstrate their abilities. I've been told that only 30% of those applying for this designation pass.) Great results and your satisfaction are what we want most.  We can help sort through the sometimes confusion array of surgical methods, incision locations, type of anesthesia etc.

You will have an opportunity to meet with Dr. Young, as well as his nurse(s) in your consultation.  Dr. Young's nurses are very familiar with the procedures he performs and not only assist Dr. Young in clinic for new patient consultations and follow up visits, but have regular duties in the Operating Suite as well.  Most of our nurses have been with Dr. Young for five years or more, and several over ten.  They can be instrumental in helping you understand the surgical procedure, coordinate after-surgery care, etc.

Your Consultation Visit is an exciting time because the possibilities are quickly seen as a reality. It is easy to overlook an important question or even feel too embarrassed to ask a question that seems silly or awkward. Making a list of your questions or concerns helps keep you focused, and ensures you'll be more ready to make a decision on whether the procedure is right for you. 

In Andrea's case of wanting to prepare for a Breast Augmentation, she would begin by scheduling her consultation appointment.  At her consultation, she will meet with Dr. Young, and one or more of his nurses for an examination, discussion of the procedure, recommendations, and a "sizing" prior to speaking with her surgery coordinator. 

The sizing is her opportunity to "try on" many different size implants in a special bra.  Andrea can then get a sense of what style and size implant is most appropriate for her.  Every woman's body type is different, and one's taste in size is different.  We encourage you to select your size based on what feels best to YOU.  You might hear from a friend that she had 450cc implants, and you think that you'd like to be that size, or maybe even a bit bigger.  Keep in mind that 500cc implants in someone who is 5'7" tall and weighs 135 pounds will look quite different on someone who is 5'2" tall and weighs 110!  Are you broad shouldered, narrow chested, pear shaped, tall or petite?  Your body type will play a big part if you're trying to achieve a more balanced, proportional look.

After the consultation visit, if a surgery date is selected, Andrea will also schedule a "pre-op" (pre-operative) visit which is usually two weeks prior to the surgery, but may be closer to the date of surgery if you schedule for a more immediate surgery (surgeries can be scheduled as soon as the following day in some cases).  At this visit she will go over her medical history with one of Dr. Young's nurses, have a physical exam with vitals and labwork performed, discuss risks, how to prepare for surgery and recovery, among other things. It is Andrea's chance to ask any other questions she's thought of as well, and to finalize the size of her implants.  The next time we see Andrea will be the day of her surgery, which is performed in Dr. Young's fully accredited in-office Surgery Center.  Our OR staff will be there for each stage of her procedure, including instructions for Andrea's friend or family member who will drive her home following her recovery.

I hope this information gives you an idea of how things can proceed once you've decided you'd like to look into cosmetic plastic surgery.  I'd like to thank Andrea, and everyone who sends us great e-mail questions.  Please continue to do so.  You can e-mail me directly at:  busmgr@dr-youngforever.com.

What's New in Breast Implants!

by Robert N. Young, MD, FACS
Board Certified Plastic Surgeon

It's been over a year since their re-launch and it appears that the new silicone implants are taking off. The softness, safety and durability of the cohesive gel is attracting a lot of patients to select silicone despite their increased cost. For a little more money than the standard cohesive gel implant, there is also a silicone implant with a saline center (the Becker implant) that can be adjusted after the surgery via a valve under the armpit. When the patient is happy with one size, the valve is then removed.

Many people still feel more comfortable with the saline implants which have been the standard for the past 15 years. At Aesthetic Enhancement Cosmetic Surgery Center, I offer all options in terms of implant type, size and shape, as well as placement of the incision. We have our own fully accredited in-office surgery center to perform the surgery. Our patients find that this provides them with the privacy and convenience they desire, while also affording the best in patient care and safety.

With the advances made in quality and selection of Breast Implants, now truly is the best time for Breast Augmentation. The new style implants can create beautiful, natural looking breasts which will enhance your figure and bring a new sense of self-confidence and beauty to you. I'd be happy to see you in a consultation appointment to see if Breast Augmentation is right for you. Contact me by calling my office at 210-496-BODY (2639) or e-mail nubody@dr-youngforever.com.

All In-Office Surgeries Are Not The Same

Dr. Young is pleased to bring you the best that San Antonio has to offer in state-of-the-art outpatient surgical care for our specialty of Cosmetic Plastic Surgery. Aesthetic Enhancement's own surgical facility, including two Operating Rooms, Pre-Op Rooms, Recovery Room, and the entire facility meets standards that rival the best of hospitals.

For many people, the "operating room" is a mystery. Many people don't have much recollection of the room because of the sedative effect of anesthesia. Years ago, some doctors set up surgical rooms in one of their back offices and performed surgeries in conditions that are largely seen as unsafe. Regulations became more strict, and facilities were encouraged to get approved in order to try to elicit safer outcomes. Dr. Young was one of the first in-office surgical facilities to become accredited by the AAAASF (American Association for Accreditation of Ambulatory Surgery Facilities). In doing so our facility had to demonstrate the highest levels of competence.

The AAAASF was established "to provide a means of measuring both medical and surgical competence, and ethical conduct, by providing an external source for the evaluation of professional credentialing, patient safety and quality of care." To ensure verifiable quality care with specific requirements, the AAAASF standards that every facility must meet include:

1. General Environment
2. Operating Room Environment, Policy & Procedures
3. Recovery Room Environment, Policy & Procedures
4. General Safety in the Facility
5. Blood and Medications
6. Medical Records
7. Quality Assessment/Quality Improvement
8. Personnel
9. Governance
10. Anesthesia

Compliance with these standards is both self-monitored and by physical inspection by AAAASF. We're pleased that our facility meets standards that rival the best of hospitals.

Dr. Young's surgery center is designed to satisfy all your cosmetic surgery needs. It provides cost effectiveness for his patients, and allows total discretion, comfort and safety. Our entire staff, all outstanding in their respective fields, work together to ensure you have a safe, comfortable experience and an outstanding surgical outcome. Both our Surgery Center and our Medical Day Spa are connected to the North Central Baptist Hospital at Stone Oak.

Don't settle for substandard care. Make sure the facility which you entrust your care is accredited. For more information visit the AAAASF website at http://www.aaaasf.org/mission.php.

New Sciton Laser - Non-Surgical Procedures With Amazing Results

For many years, Dr. Young and Aesthetic Enhancement Cosmetic Surgery & Laser Center have been in the forefront with the latest technologies in skin care. With the addition of our new Sciton ProFractional Laser, we're able to offer a wider range of treatments and options in terms of down-time.

Traditional Laser Resurfacing, for instance, while affording great results, has long down-times that many busy men and women simply cannot take. With the Sciton ProFractional Laser and the Sciton MicroLaserPeel, resurfacing has been brought into the future by reducting downtimes to as little as a few days. The Sciton also offers advances in BBL/IPL treatments to treat age spots, redness, broken capillaries and remove unwanted hair. The SkinTyte is designed to tighten skin and stimulate production of your body's own collagen. Combined with the BBL, we see improvement in tightened skin and reduction of sun damage, fine lines and wrinkles.

We'll bring more detailed news on how this new technology works, and what it can do for you, in future articles and invite you to join our newsletter by signing up (you can register by following the link to the right). Get the latest news in Cosmetic Plastic Surgery and Professional Skin Care. If you would like more immediate information on how you may benefit from these technologies, please call our office at 210-496-BODY (2639) and ask for a complimentary Sciton consultation.

Buttock Lift Requests Are On the Rise

We've noticed a big increase in the number of women requesting Buttock Lifts, and more specifically the Brazilian Butt Lift.

Once a procedure more commonly requested by weight loss patients, usually post-gastric bypass, who had received a Tummy Tuck, and needed tightening of the upper gluteal area due to the loose hanging skin. Doctors in Brazil made the procedure popular by adding liposuction and fat transfer to the Guteal Lift procedure, thus coining the term "Brazilian Butt Lift", which had patients flocking to Rio de Janeiro to have their buttocks shaped into a more voluptuous, taut rear end!

Dr. Young performs the Brazilian Butt Lift by collecting fat via liposuction from the flanks, hips or thighs, and using fat transfer methods, re-injects the fat into the buttocks to add fullness where needed. This sculpting creates a curvier silhouette, and is an excellent alternative to Buttock Implants, which can be prone to complications such as implant infection rejection and perforation.

To see if you are a good candidate for the Brazilian Butt Lift, contact Dr. Young's office at 210-496-2639 for a consultation appointment.

About Dr. Young

Dr. Young is a well-known Plastic Surgeon in the San Antonio area, and has a reputation as one of the leading Breast Augmentation specialists. He is a Board Certified Plastic Surgeon, and has been specializing in Cosmetic Plastic Surgery for over 19 years.

Dr. Young earned his undergraduate degree from the esteemed United States Military Academy at West Point, and completed his medical degree at Tulane Medical School in 1975. Dr. Young finished his general surgery residency at Brooke Army Medical Center in 1980, and went on to serve as Chief of Plastic Surgery, where he performed all types of major reconstructive procedures.

Following Dr. Young's accomplished military career, he went into private practice, founding Aesthetic Enhancement Cosmetic Surgery & Laser Center in 1990. His vision was to bring the most innovative cosmetic surgery procedures to his patients in a comfortable and professional environment. Dr. Young pioneered one of the first in-office Outpatient Surgery Centers which specialized in cosmetic plastic surgery here in San Antonio. His surgical facility is accredited by the AAAASF (American Association for Accreditation of Ambulatory Surgery Facilities), and is designed to provide cost effectiveness for the patient, while allowing total discretion, comfort and safety.

Dr. Young has limited his practice to cosmetic surgery to concentrate his skills on the aesthetic improvement of his patients' beauty. Incorporating the latest technological procedures, Dr. Young specializes in endoscopic (minimal incision) axillary breast augmentation, and remains a leader in the field of liposuction. Providing cosmetic surgery for total body enhancement, he offers all types of breast surgery, tummy tuck, body sculpting, and facial surgeries such as face lift, eyelid surgery and laser resurfacing with state-of-the art lasers including the Sciton.

Dr. Young is an accomplished athlete, having competed in many local and national tri-athlete competitions, marathons and biking events. When not working, training or competing, he spends time at home with his wife, three wonderful dogs and two cats.