Blog
March 6th, 2013 Ronald M. Friedman, MD
Question: Ultrasonic liposuction, laser liposuction, tickle liposuction, body jet liposuction, liposculpture, power-assisted liposuction: the number of liposuction technologies can be overwhelming. Should you go to the guy with the laser machine, or should you visit the guy who uses sound waves to break up fat?
Answer: You should probably visit the surgeon who has the best credentials, bedside manner, and before/after photos. The technology is usually secondary. In fact, a surprisingly high proportion of the physicians performing liposuction have no formal background in plastic surgery; many are gynecologists, general surgeons, internists, and family doctors. Their motivation is understandable. As health care reimbursement declines, many move outside their specialty training in an effort to improve their bottom line. Many of these physicians purchase the “newest technology” and take weekend courses to learn how to use it. Unfortunately, the machine is just a machine. It requires extensive training, expertise, and experience to achieve quality liposuction results.
Perhaps the best analogy is that of an artist. Suppose that you provide a drawing novice the best pencils, canvas, easel, and drawing room that money can buy. Now give an experienced artist the nub of a used-up pencil and an old piece of typing paper. Who do you think will produce the better drawing?
By way of disclosure, I have been performing liposuction for 18 years using a superwet technique. In my private surgery center in Plano, I inject a “wetting” solution of local anesthesia, epinephrine, and saline followed by liposuction via a cannula (hollow tube) connected to a suction machine that produces a vacuum. The technology is relatively modest; you can judge the results for yourself. You may also be interested in learning that I have been performing wood and marble sculptures for about 30 years. I am tired of hearing the term, “liposculpture,” from physicians who have no artistic background and have never sculpted anything in their lives.
I am not suggesting that you should ignore technology altogether. Certain patients may be better served by certain machines. However, it is my impression that for the vast majority of patients, the liposuction surgeon is far more important than the machine.
Liposuction of abdomen, hips, flanks, inner and outer thighs
Before front Before side Before back
After front After side After back
Liposuction of abdomen, flanks, and lumbar regions
Before front Before side Before back
After front After side After back
Liposuction of knees
Before After
Liposuction of submental (under the chin)
Before After
Ronald M. Friedman is a board-certified plastic surgeon providing liposuction, tummy tucks, and breast surgery to the Plano, Frisco, Allen, Fairview, and McKinney communities. He is the Director of the West Plano Plastic Surgery on the campus of Texas Health Presbyterian Hospital of Plano.
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January 11th, 2013 Ronald M. Friedman, MD
The basic answer is 1. no, 2. yes, and 3. maybe.
What am I talking about?
1. No. Right after surgery, I do not have my breast augmentation patients wear a bra. Why not? I am obsessive about making sure that there is absolutely no bleeding before I finish surgery. Therefore, compression of the breasts with a bra or ACE bandage is unnecessary—and probably quite uncomfortable. In addition, your implants will start out too tight and too high (please see blog, “Are My Breast Implants Supposed to Be This Tight and This High?”). If your breasts are already too tight and high, they really don’t need the additional support of a bra.
2. Yes. Within a few weeks of surgery, your implants will settle to some degree. Once they look as if they “belong” on you (and no longer look “funny”), you should begin wearing a bra close to 24/7 (yes, that means sleeping in it too). Ideally, you should wear a sports bra that fastens in front and has no under wire. The bra should be worn all the time until you are 6 months post-op. Why 6 months? Your body will form a capsule (thin scar surrounding the implant) that will take approximately 6 months to mature
Image provided by Intuition
3. Maybe. Once the capsule surrounding your implants matures, it acts as an “internal bra,” supporting the implants. If you had minimal breast tissue prior to surgery, regular use of a bra may no longer be required. On the other hand, if you had a moderate amount of breast tissue before surgery, you may still want to wear a bra (but not 24/7), since the capsule will only support the implants (and not the overlying breast tissues).
Summing it up, the implants will hold themselves up at first. Once the tissues relax, you will need an external bra for about 6 months. After 6 months, the scar tissue surrounding the implants will act as an internal bra.
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
Posted in Breast Augmentation, Breast Implants, Home, Plastic Surgery | No Comments »
December 28th, 2012 Ronald M. Friedman, MD
I hear this question at least a few times a week. Yes, all breast implants start out too high and too tight. And yes, they do relax, soften, and settle to a more natural position.
What’s going on? When implants are first placed, the skin and pectoralis muscle are placed under tension by the implants. The skin will look tight and shiny, and the muscle will contract against the implants, displacing them upward (Figure 2). Within a month or two of surgery, the skin and muscle will stretch and relax, causing the implants to feel softer. The muscle will release its grip on the implants, allowing them to fall (Figure 3). Even at a month after surgery, the implants will not reach their final softness or position; it will actually take about six months (Figure 4).
If you’re wondering why we can’t just “put them in the right place to begin with,” consider that if your implants look just right on day #1 after surgery, they will probably look too low by six months after surgery. Ideally, we want your breast implants to start high and end up in just the right position.
Before Surgery 1 week post-op 2 months post-op 8 months post-op
(Figure 1) (Figure 2) (Figure 3) (Figure 4)
Check out these articles to find out more information about choosing the right size implant for you and to learn about the differences between Saline and Silicone Gel implants.
If you have any questions or wish to schedule a free consultation call our office at 469-467-0100.
Dr. Friedman is the Founder and Director of the West Plano Plastic Surgery Center on the campus of Presbyterian Hospital of Plano. He also has a Flower Mound office that serves the Lewisville, Denton, and Coppell areas.
Posted in Breast Augmentation, Breast Implants, Plastic Surgery | No Comments »
October 29th, 2012 Ronald M. Friedman, MD
Repair of torn earlobes
 Before |
 After (2 weeks) |
Dangling or heavy earrings, babies and toddlers pulling on earrings, piercing that are too low; these are among the many causes of torn earlobes. Sometimes the earring just droops in a stretched-out piercing site (incomplete earlobe tear). Sometimes after years of stretching, the earlobe just splits in half (complete earlobe tear).
Regardless of the cause and severity of the tear, torn earlobes can be repaired under local anesthesia in the West Plano Plastic Surgery Center. The cost is quite reasonable at $375 for one ear or $650 for both (assuming single, uncomplicated tears in each ear). We have laughing gas available at no additional charge.
The skin lining of the tear is removed, and the earlobe is repaired with two to three layers of stitches (inner ear skin, outer ear skin, and soft tissue between the skin each receive a layer of stitches). The earlobes may be re-pierced at the same time (no additional charge). You may bring small studs with you or pick them up at the Presbyterian Hospital of Plano gift shop one floor below our office.
Beautiful earrings look much better in beautiful ears.
Earlobe reduction for large earlobes
Some people have large earlobes. They may have simply developed that way, or they may have stretched due to heavy earrings or aging. Regardless of the cause, the result is a dangling, distractingly large earlobe.
Earlobe reduction may be performed under local anesthesia (with laughing gas, if desired, at no additional charge). If the earlobe also happens to be torn, this can be repaired at the same time (also at no additional charge). In fact, sometimes the torn part of the earlobe can be removed as part of the earlobe reduction.
 Before |
 After (2 months) |
Most commonly I perform removal of redundant earlobe tissue through an incision along the edge of the earlobe (Patient 2, above). Essentially, you and I agree upon the new size and curvature of the earlobe, and this is drawn onto your ear. Then the excess skin and soft tissue is removed—staying exactly on that line. The intervening earlobe edge’s soft tissues are thinned, and the earlobe is repaired. This technique primarily shortens earlobes that are too long.
 Before |
 After (2 weeks)
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An alternative method is to perform a wedge-shaped excision of redundant earlobe tissue (Patient 3, above). This creates a vertical scar (instead of a curved horizontal one) and enables narrowing of earlobes that are too wide, as well as some shortening of length.
Either procedure works well, and we can decide together which one will best suit your anatomy and preferences.
Repair and reduction for gauged earlobes
Gauging the ears is popular with many teens and twenty-somethings. Unfortunately, it leaves the earlobes severely stretched and deformed. Many patients choose to repair gauged earlobes due to the eventual cosmetic appearance or due to lack of acceptance by workplaces and the military. Repair of gauged earlobes entails a combination of torn earlobe repair and earlobe reduction. The thinned rim of tissue along the lower part of the earlobe is removed as a wedge excision, creating a vertical incision in much the same way as a wedge earlobe reduction procedure (see above). The more stretched the earlobe is prior to repair, the smaller the earlobe will be after repair.
 Before |
 After (2 weeks)
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For more information, including before and after photos of earlobe repairs and reductions, please visit www.plasticsurgerydallas.com or call us at 469-467-0100.
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
Dr. Friedman is the Founder and Director of the West Plano Plastic Surgery Center on the campus of Texas Health Presbyterian Hospital of Plano. He has been named Best Plastic Surgeon by D Magazine for 5 consecutive years and is the 2012 plastic surgery winner of the Best of Plano and the Best of Denton. He has offices in Plano and Flower Mound and serves the Frisco, Allen, McKinney, Colleyville, Grapevine, and Southlake communities.
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October 15th, 2012 Ronald M. Friedman, MD
The average plastic surgeon performs about 30 to 35 breast augmentations annually. I performed 135 breast enlargements in 2011. The best way to evaluate a surgeon is to look at his surgical results. As a specialist in breast and body contouring, I strive to achieve natural and proportionate breast enlargement results.
Remember that the single greatest factor determining the appearance of your breasts after augmentation is the appearance of your breasts before augmentation. As you view the photos below, notice that a woman’s breast shape changes very little with augmentation. The primary changes are increased breast size and increased fullness of the upper breasts.
1. Breast Augmentation with Saline Implants:
Implant size: 330 cc implants; Incision: Inframammary fold
Estimated size change: 34B to 34C; Height and Weight: 5’7″, 119 lbs
Before After Before After
Front view Side view
2. Breast Augmentation with Saline Implants:
Implants: 420 cc implants ; Incision: Inframammary fold
Estimated size change: 36B to 36D Height and Weight: 5’9″, 140 lbs
Before After Before After
Front view Side view
3. Breast Augmentation with Saline Implants:
Implant size: 330 cc implants; Incision: Inframammary fold
Estimated size change: 34c to 34D; Height and Weight: 5’4″, 122 lbs
Before After Before After
Front view Side view
4. Breast Augmentation with Saline Implants
Implant size: 360 cc implants; Incision: Inframammary fold
Estimated size change: 34 small B to Full C; Height and Weight: 5’4″, 130 lbs
Before After Before After
Front view Side view
5. Breast Augmentation with Saline Implants
Implant size: 360 cc implants; Incision: Inframammary fold
Estimated size change: 34B to 34 Full C; Height and Weight: 5’0″, 95 lbs
Before After Before After
Front view Side view
6. Breast Augmentation with Silicone gel implants
Implant size: 421 cc implants; Incision: Inframammary fold
Estimated size change: 32B to 32C; Height and Weight: 5’5″, 120 lbs
Before After Before After
Front view Side view
Our breast augmentation patients come from all over Texas (Dallas, Fort Worth, Lubbock, Denton, Wichita Falls, Austin), Oklahoma, Arkansas, and Louisiana.
For blogs that I have written on specific breast enlargement topics, please see:
- Determining breast implant size
- Saline vs. silicone gel
- Safety of silicone gel
- Low, moderate, and high profile implants
- Smooth vs. textured implants
- Implant placement above vs. below muscle
- Capsular contracture
For articles that I have written on specific breast enlargement topics, please see:
- Cost of breast augmentation
- Breast augmentation with vs. without breast lift
Check out our website for more before and after photos.
Ronald M. Friedman, M.D.
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
Posted in Breast Augmentation, Breast Implants, Home, Plastic Surgery | No Comments »
October 12th, 2012 Ronald M. Friedman, MD
I am fully aware that Botox and facial fillers are available on practically every street corner. Doctors’ and dentists’ offices, medical spas, and even beauty parlors offer injectables. Patients are routinely injected by gynecologists, dentists, nurses, aestheticians, medical assistants, and occasionally personnel with no formal medical education. The results of the injections are variable: some are pretty good, and some are awful.
In contrast to the other injectors, plastic surgeons make their living by operating on people, not by injecting them. I am no exception. So why do I personally perform every injection?
Botox to glabella
 Before |
 After |
Restylane to the nasiolabial folds
 Before |
 After |
Because I’m good at it. With an artistic background as a wood and marble sculptor and a medical background as a plastic surgeon, I feel better qualified to perform Botox and Restylane injections than the nurses and medical assistants in my office. I understand the anatomy of the facial muscles better than your dermatologist—because I perform surgery on those very same muscles. I can mark the muscles for injection based on your unique anatomy, rather than using a standardized diagram provided by the medical manufacturers. I know that Restylane and Juvederm are not interchangeable products, and I understand when to use each. I did not develop my knowledge through a weekend course at a hotel; instead, I developed it over 17 years as a board-certified plastic surgeon.
If I am the most qualified person in my office to perform injectables, I cannot delegate this duty to anyone else. I really do care about doing my best for my patients, and I am compulsive about providing consistent, quality results. Although I could hire an aesthetician or train a nurse injector, I still believe that if you want something done right, you have to do it yourself.
Ronald M. Friedman
Director, West Plano Plastic Surgery Center
Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas
www.plasticsurgerydallas.com
Dr. Friedman prides himself on personally performing every Botox, Dysport, Restylane, and Juvederm injection. Although ice is suitable for many patients, he believes that it is unfair to charge extra for patient comfort. So he provides effective topical anesthetics and/or 70% nitrous oxide (laughing gas) at no additional charge. Our practice serves the Plano, Frisco, Allen, and McKinney communities.
Please visit our website for more before and after Botox and Dysport photos and before and after Restylane and Juvederm photos of patients who have been injected by Dr. Friedman.
Posted in Botox and Dysport, Face, Home, Plastic Surgery, Restylane and Juvederm | No Comments »
September 25th, 2012 Ronald M. Friedman, MD
A saddle nose entails a concave or “collapsed” look on nasal profile, resembling the shape of a saddle. Some people’s noses just happen to look that way. Other people may develop saddle noses following nasal trauma, infection, or rhinoplasty. Typical treatment for saddle noses is complex. It generally involves a rhinoplasty (“nose job”) with placement of cartilage grafts taken from the nasal septum, ear, or even a rib. I have found Restylane to be a safe, convenient, and relatively inexpensive alternative to major nasal surgery and grafting in patients with saddle noses. Restylane is a clear gel that is injected into facial wrinkles and folds to provide better contour and volume. While it is usually used for the lips and cheeks, it is also beneficial in improving the concave or sunken profile associated with saddle noses. Restylane involves no surgery, no surgical incisions, and no surgical recovery. It generally lasts about six months, so there is also no commitment. This means that you can always do a rhinoplasty once the Restylane reabsorbs–but I doubt that you will.
Before After
Before After
Saddle nose injection with Restylane
Ronald M. Friedman Director, West Plano Plastic Surgery Center Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas www.plasticsurgerydallas.com Dr. Friedman is the Founder and Director of the West Plano Plastic Surgery Center on the campus of Presbyterian Hospital of Plano. He also serves the Frisco, Fairview, Lucas, and Wylie communities.
Posted in Face, Home, Plastic Surgery, Restylane and Juvederm | No Comments »
May 17th, 2012 Ronald M. Friedman, MD
I have a complaint. When demonstrating before/after results for tummy tucks, most plastic surgeons carefully select women who are 5’4” and weight 120 lbs and then show an amazingly flat tummy after surgery. For some reason, many of the patients I see for tummy tuck have less-than-ideal proportions before surgery. In my experience, these patients are more challenging, but the results are frequently even more gratifying.
Unbeknowst to me, one of our patients has been describing her experience, both before and after surgery, on a major website, realself.com. She is a 35 year-old woman who is 5’6” in height and weighs 203 lbs. She previously weighed 339 lbs but lost 137 lbs following gastric bypass surgery. She complained of extreme dissatisfaction with the appearance of her abdomen after massive weight loss.
She underwent full abdominoplasty (tummy tuck) in our West Plano Plastic Surgery Center on March 2, 2012. Her before and two month postoperative results are below. Final results are anticipated at approximately one year.
Full tummy tuck:
Before front After front
Before side After side
Click here for a complete description of her experience—in her own words.
For more information about tummy tucks, including more before/after photos, please click here.
Dr. Friedman is a board-certified plastic surgeon who specializes in breast and body contouring in Plano, Texas. In practice for 17 years, his office at Presbyterian Hospital of Plano serves the Frisco, Allen, and McKinney, Texas areas. He also has a Flower Mound office that serves the Lewisville, Denton, and Coppell areas.
For more information about Dr. Friedman, please visit www.plasticsurgerydallas.com.
Posted in Home, Plastic Surgery | No Comments »
May 16th, 2012 Ronald M. Friedman, MD
Tummy tuck without Liposuction
Before (actual patient) After (actual patient)
Tummy Tuck with Liposuction of Hips, flanks and upper torso
Before (actual patient) After (actual patient)
A full tummy tuck (abdominoplasty) improves the appearance of the abdomen following pregnancy or weight loss by addressing excessive skin, excessive fat, and abdominal wall laxity:
- Excessive skin: all skin from the umbilicus (belly button) to the pubic area is removed. The remaining upper abdominal skin is advanced downward and tightened.
- Abdominal wall laxity: the entire abdominal wall is tightened (typically 4 to 5 inches) by permanent stitches into the fascia (fibrous tissues between the rectus abdominis muscles).
- Excessive fat: all fat below the navel is removed, corresponding to the area of skin removal.
The big question: What do you do with the excessive abdominal fat above the navel? The answer is not as obvious as it seems. Many plastic surgeons are reluctant to perform liposuction of the upper abdomen during a tummy tuck for fear of problems with reduced blood flow to the tissues. Specifically, they are concerned that if you elevate and advance the tissues, suctioning them at the same time may create too much trauma.
The problem: If you don’t liposuction the upper abdominal tissues, your abdomen may still protrude excessively after surgery, potentially requiring a second surgery for abdominal liposuction at a later date.
The solution: I routinely perform liposuction of the abdominal wall during tummy tucks. The key is to be conservative with the amount of suction performed, so that the procedures can be combined safely. Fat removal must be done conservatively to preserve blood supply to the abdominal skin and remaining fat. Even greater care must be taken with diabetics (who must be well-controlled) and smokers (who must be off cigarettes), as both of these groups are at greater risk for blood flow compromise.
Judicious liposuction during tummy tuck can improve the cosmetic surgical results while preserving patient safety.
Dr. Friedman is the Founder and Director of the West Plano Plastic Surgery Center on the campus of Presbyterian Hospital of Plano. He also serves the Fairview, Lucas, and Wylie communities.
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March 28th, 2012 Ronald M. Friedman, MD
Botox is now available at a reduced cost of $275 for the first 25 unit syringe ($11 per unit) and $225 for the second 25 unit syringe ($9 per unit). This promotion is supported by Allergan, the manufacturer of Botox, and is good through April 30. Our usual charge is $325 for the first syringe, but we can now provide a $50 rebate for patients who enroll in the Botox Rewards Program.
Dysport, an FDA-approved competitor of Botox, if offering a similar $50 rebate on the first syringe. A 75 unit syringe of Dysport (equivalent to 30 units of Botox) is now available for $275.
The best part: these offers can be combined. For example, if you have a syringe of Botox to the lines between your eyes and a syringe of Dysport for the crows feet during the same visit, your regular cost would be $325 (first syringe) plus $225 (second syringe) = $550. With these combined offers, you can save $50 on each syringe, yielding a total savings of $100.
Two syringes (one Botox, one Dysport) for $450 is an excellent deal (equivalent to $8.20 per Botox unit).
Also consider that every injection is personally performed by board-certified plastic surgeon, Ronald M. Friedman, M.D., who has been in practice in Plano and Flower Mound for 16 years. We also have numbing cream and laughing gas available at no extra charge.
Botox to Glabella Before Botox to Glabella After
Dysport to Crows feet Before Dysport to Crows feet After
Dr. Friedman has always prided himself on personally performing every Botox, Dysport, Restylane, and Juvederm injection. Although ice is suitable for many patients, he believes that it is unfair to charge extra for patient comfort. So he provides topical anesthetics and/or 70% nitrous oxide (laughing gas) at no additional charge. Our practice also serves the Frisco, Richardson, and Garland communities.
Please visit our website for more before and after Botox photos of patients who have been injected by Dr. Friedman.
Posted in Face, Home, Plastic Surgery | No Comments »
