Robert Silich MD | New York Plastic Surgery Blog

Q:What is the best way to manage pain of minor 1st Degree and 2nd Degree Burns?

A:A local anesthetic is usually sufficient; also Aloe Vera can be used to heal the burn area. However, systemic anti-inflammatory drugs such as naproxen may be effective in mitigating pain and swelling. Additionally, topical antibiotics such as Bacitracin and Neosporin are useful in preventing infection to the damaged area. Lidocaine can be administered to the spot of injury and will generally negate most of the pain.

Q:How come a “nose job” doesn’t need to be done in the hospital?

A:Mainly, the big difference with rhinoplasty in particularly is the advent of quick acting non-narcotic anesthetic agents. Rhinoplasty as opposed to other kinds of plastic surgery deals with deeper structures such as the bone and the cartilage and tends to be a little more painful to undergo under local anesthesia with some sedation, and therefore the anesthetics that traditionally had been used were general anesthetics. Today the vast majority of cosmetic nasal surgery is performed with local anesthesia and modern medications which allow for deep sedation with complete patient safety without the need for general anesthesia.

Q:Who is a good candidate for a full neck-lift?

A:Good candidates are usually people with excess skin laxity and skin that does not really respond well to microsuction alone. In other words, skin that’s particularly seen in people that are older, a lot of sun-damaged skin not particularly fat people but usually elderly people that have a lot of loose skin.

Q: Is there scarring in Microsuction?

A: Not at all. You can barely see it. We make a small incision underneath the chin that’s the size of a staple. Most people interesting enough, tend to have a little scar under the chin from falling as a child, and we can use that. If somebody is very squeamish about making an incision underneath their chin, we can make 2 small incisions behind the earlobe and the instrument we use (a cannula) will then reach behind the ear to underneath the chin. But usually just under the chin, no one will see it

Q: Is a limited incision face-lift a procedure that’s permanent like a normal face-lift?

A: Yes, it is permanent. This procedure really started to become popular in the last 10 years. We are just starting to see these patients now 10 years after surgery with virtually about the same results that you would get from a full face-lift. Some people argue that a limited incision face-lift will keep you going for a good 7-10 years whereas the more classic face-lift can take you to 15 years but I think that the trade off between the incisions and the length of operative time (longer for the classic face lift), is probably not worth it for the time difference.

Q: Does the hair grow back in a brow lift?
The hair does grow back but based on the concept of the brow lift procedure itself, the hairline usually moves farther posteriorly. Most of the time this is the desired result and is aesthetically pleasing and the basis for the procedure. The ideal candidate therefore for a traditional brow lift procedure is usually someone who has either an average or lower than average hairline.

There are also some modifications to the incisions in brow lift surgery that allow for less than ideal candidates to still undergo brow lift surgery. These are direct hairline incisions; eyebrow border incisions and of course endoscopic brow lift surgery.

Q: Is there a risk of nerve damage with a neck-lift?
Nerve damage with a neck-lift is usually very limited. The most commonly injured nerve is a sensory nerve that supplies the area of the earlobe. This nerve is called the ‘great auricular nerve’, which lies along the border of the sternocleidomastoid muscle which helps turn the head from side to side. This is a nerve that is very rarely cut or injured but it does get bruised and can cause some temporary numbness along the earlobe. This can last for a few days or even up to a couple of months. The feeling almost always returns and most people don’t even notice it.

Q: After a face-lift, will someone be able to have a natural-looking smile?
Yes, of course. In fact ultimately, the smile should not change at all. Something that can change the smile would be swelling or bruising around certain nerves of the face. Having said that, the smile can look uneven for the first or even several weeks after surgery, if not longer. The nerves that affect the smile very rarely get injured directly but are so sensitive that even a small amount of indirect swelling or inflammation around the nerves can cause a weakness after surgery

After face-lift surgery, very often people will have a little bit of an uneven smile. They may not even notice it, but the surgeon usually would be able to evaluate this. The inflammation and swelling ultimately subsides and the smile returns to baseline.This period is the time for patience and reassurance from your surgeon and a conservative approach.

Dr. Robert Silich was invited to appear on the Neil Cavuto Show on the Fox Cable News Network channel yesterday to speak about an Argentinean doctor who was recently released from prison for perpetrating a plastic surgery scam on some of Hollywood's elite.

Priscilla Presley and other celebrities had gone to Dr. Daniel Serrano around 2003 and began receiving what he claimed were miracle injections that worked better than Botox. In fact, Serrano was injecting industrial, low-grade silicone similar to what's used to lubricate auto parts in Argentina into her face.

The injections by Serrano (who was not a licensed physician in the U.S.) allegedly caused several complications including facial paralysis and infections in some of the patients he injected.

Dr. Silich had this to say: “Unfortunately it is an all too common scenario. People to do more research looking at a home or buying a computer than they would for looking into a doctor. I wish I could say that this is an exception to the rule, but it's really not, it happens all too frequently and unfortunately it happens with the kind of people that you think it would never happen with."

Q: What material is used to enhance the shape and size of a woman’s breasts during augmentation mammoplasty?
A: Augmentation mammoplasty basically is increasing the size of the breasts by using breast implant devices. It can correct not only small breasts but it can also correct a certain degree of ptosis which is breast sagging. There are 3 levels of ptosis: first, second and third degree. A breast implant alone usually is able to correct very mild first to second degree ptosis without having to do a formal breast lift which has more scarring. The two materials that are used in breast augmentation are saline (salt water) and silicone gel implants. In 1993 silicone implants were taken off the market by the FDA and have actually been further studied since then and now have re-emerged back on the market for general use and augmentation. They have always been used for congenital deformities and for breast cancer reconstruction but they were taken off the market for cosmetic augmentations for a period of about 14 years.