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Category: Plastic Surgery

Product Placement and Plastic Surgery

When shopping for a plastic surgeon, look for surgical skill rather than products.

Smartlipo, Fraxel, Sculptra, Zerona, Velasmooth: the array of plastic surgery products is increasingly complicated and confusing.  Much of this is related to marketing of products directly to consumers, both by physicians and manufacturers, in order to create product demand.  Instead of calling my office to ask how many liposuction surgeries I have done, people call to find out whether I have CoolLipo available.  Instead of asking how many breast augmentations I have done, they want to know whether I offer “gummy bears.”Torso-Granadillo

This is an unfortunate mistake.  There are gynecologists who do “LASER lipo” and ear/nose/&throat doctors who place the latest implants.  However, the ability to purchase a particular product does not always translate into competency in using it.

When you are researching cosmetic surgery, remember that the surgeon doing the procedure is far more important than the product he or she is using.  Saline breast implants placed by someone who has done 2000 augmentations will generally look far better than the latest silicone gel breast implants placed by someone who has placed 20. This is not to say that product choice is unimportant; some products are clearly better than others for certain patients.

Before you worry about the specific product a surgeon uses, look at his education and experience.  Look at his before & after photos–not just one or two, but twenty or thirty.  Look at his online reviews. Observe his bedside manner.  Evaluate the cleanliness of his office.  Speak to patients of his who have had the procedure that interests you.  Then, after all of that, worry about the “products” he offers. If you select the right surgeon, you’ll probably get the right product anyway.

If you have any questions or wish to schedule a 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.

Surgeon Vs The Machine

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

Before / After

Liposuction of submental (under the chin)

Before / After

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.

Wearing A Bra After Breast Augmentation

When a patient comes in and ask if she needs to wear a bra after breast augmentation surgery 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

High And Tight Breast Implants

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.


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.



Earlobe Repair and Reduction: Everything You Always Wanted to Know

Repair of torn earlobes

Before torn earlobe repair


after torn earlobe repair

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 $425 for one ear or $725 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 earlobe reduction


after earlobe reduction

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 earlobe reduction wedge


after earlobe reduction wedge

After (2 weeks)                                              

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. For more information about gauged earlobe repair including pricing please call our office at 469-467-0100.

before gauge repair


after gauge repair

After (2 weeks)                                                      

For more information, including before and after photos of earlobe repairs and reductions, please visit 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 6 consecutive years and is the 2012 plastic surgery winner of the Best of Plano and the Best of Denton.  He has an office in Plano and serves the Frisco, Allen, McKinney, Colleyville, Grapevine, and Southlake communities.

© 2018 Ronald M. Friedman, M.D., P.A.

Contact Us At 469-467-0100

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