Austin Texas Board Certified Plastic Surgeon


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Happiness and Plastic and Cosmetic Surgery

I wanted to be a Plastic Surgeon at a very young age, 12 years old. At the young age, I was enthralled with the opportunity plastic surgeons had to help improve the lives of their patients by enhancing their appearance.  Thus Plastic Surgery, and Cosmetic Surgery in particular, holds special meaning for me.  It is a medical discipline that is focused as much on the how people feel as the way they look.  I see the goal of Cosmetic Surgery as not just to modify the outside of one’s nose, face, or body but to generate happiness.  That is a bold statement, but I believe it is true.  Why else would people part with their hard-earned money, embark on an endeavor infused with inherent uncertainty, and take time out of their busy lives for the necessary recovery.  Happiness is what patients seek.  I have learned this, I respect this, and it is what guides my every action, every thought, and every decision when I take care of my patients.  It is important to note that I don’t believe that Cosmetic Surgery alone can create happiness.  In order to benefit from the changes Cosmetic Surgery can provide, a patient has to have the capacity to be happy, to be content.  Fortunately almost all patients do have that capability.  One of my biggest responsibilities as a Plastic Surgeon, as a doctor, is to hear and understand a patient’s goals, aspiration, and motivations and match those with an explanation of anticipated result outcomes, patient experience, and anticipated positive emotional impact.  When during a consultation, I am able to “look inside” a patients head to “see” what they are expecting and let a patient “peak inside” my head to “see” what I believe I can deliver; happiness is ultimately the result.  I call it the “Cosmetic Surgery Consultation Mind Meld.”  Understanding one another creates beneficial expectations and perceptions – and that is everything.  Hope to see you soon.

Rhinoplasty Top Ten Frequently Asked Recovery Questions

The Top Ten FAQ’s After Rhinoplasty (Week #1)

The following information with help provide some basic information about the rhinoplasty recovery process.

  1. When do I start my medications?

Start the antibiotic the evening of the operation

Start the Steroid the evening of the operation. Take the last day single dose that night.  Then the next day start with day #1 of the taper.

  1. How long do I sleep in a head elevated position?

3 days

  1. How long will I have sinus pressure?

For one week. It will end when the internal splints are removed.

  1. When should I start light activity such as walking?

The day of the operation if you are comfortable, but certainly the next day.

  1. When do I start nasal saline spray and antibiotic ointment?

The day of the operation

Spray the nasal saline in each nostril 4 times daily.

Place some bacitracin antibiotic ointment just in the inner rim of the nostrils twice daily with a cotton swab

  1. Is it normal to have some bleeding?
  2. When can I shower?

The day after surgery, but the splint must be kept dry. It is best not to attempt to wash your hair or face in the shower.  Also it is good to use lukewarm water.  Hot water can cause sweating.  That and the steam can make the splint detach from the nose.

  1. How long do I need to have someone around to help?

At least 24 hours. But you might not feel well enough to drive for a full 7 days.

  1. If I have bruising under my eyes how long will it be present?

7-10 days generally

Arnica Montana and Bromelain can help make it go abate faster

  1. What do I do if I have a concern or need to have a question answered?

Call the office. During business hours you can speak to someone in our staff.  After hours the recording will give directions on how to have me contacted.

Rhinoplasty – Brings Tears to the Eyes in Good Way

I have the good fortune to be able to be able to help patients with cosmetic rhinoplasty and functional airway surgery in Austin, Texas.   The spectrum of Rhinoplasty patients that I care for is broad.  At one end of spectrum or the patients who require relatively straight forward rhinoplasties.  These are the patients who desire a minor change to one or two portions of their nose.  I should mention that using the “straight forward” when describing any rhinoplasty is a bit of a fallacy.  All rhinoplasties need to be approached with respect as they require precision and patience to achieve a natural result.  Nonetheless, at one end of the spectrum the surgery is straight forward and designed to address a dorsal hump or a bulbous tip.  At the other end of the spectrum are the complex rhinoplasties.  These are the rhinoplasties that address nasal deformities that are congenital in nature, such as a in association with a cleft lip, or due to significant injury like a care accident.  These are not straight forward at all.  They often can take 50% or more longer than a typical rhinoplasty and often require rib and/or cartilage grafts.  These grafts are used during the rhinoplasty to create onlay grafts, alar rim grafts, lower lateral strut grafts, and tip grafts.  Rhinoplasty for the severely deformed or damaged nose is often a procedure of reconstruction and addition of foundation and support structure.  Again, I prefer to do this with natural tissues instead of foreign material such as Goretex or irradiated cadaveric cartilage.  Both ends of the spectrum are very rewarding as it is very gratifying to make someone’s nose function better and look better.

Fillers and Fat Grafting Beneath the Eyebrows – Austin Texas

Most people are familiar with noninvasive injection procedures such as Botox, Juvederm, and Restylane. Fat grafting has now become a very popular procedure to restore volume to the face. One of my favorite areas to use Juvederm and fat grafting recently has been beneath the eyebrows. Look at any fashion magazine and you will see that the tissue beneath the eyebrows of the young attractive models is full. It pushes out; it is convex. As the face ages and in some younger individuals this area becomes depleted of fat and soft tissue and thus become flat. This creates and aged appearance and also makes the eyelids below this region sag more. Injecting fillers and fat into the soft tissue beneath the eyebrows restores fullness and creates more youthful appearance. The result is both subtle and profound at the same time. I am really excited about this procedure at the moment. It works well as a stand-alone procedure or can be combined synergistically with a facelift, blepharoplasty, and even unrelated procedures such as a rhinoplasty or liposuction.

Electronic Cigarettes and Cosmetic Surgery: Be Safe – Quit Before You Go Under the Knife

Electronic cigarettes are a smoking alternative that generates a vapor that is inhaled into the lungs of the user. The vapor contains many chemicals including nicotine. At present, electronic cigarettes represent a billion dollar industry. This pales in comparison to the tobacco cigarette market, but it is predicted that in the next ten years sales of electronic cigarettes will be equal to those of their tobacco containing counterparts. The increasing use of electronic devises creates the need for more information and discussion about how their use impacts cosmetic surgery and healing from cosmetic surgery. First, it is helpful to understand the effects of smoking traditional tobacco cigarettes.

Smoking traditional tobacco cigarettes has detrimental effects on tissue healing that are well established in the scientific literature. For this reason smoking is discouraged, often prohibited, for up to four weeks prior to, and for up to two weeks following, elective cosmetic surgery by most surgeons. Tobacco contains many chemicals that alter human physiology in a manner that brings about poorer results in wound healing and thus increased risks of complications with elective cosmetic surgery.

One way to categorize these tobacco smoke related chemicals is to think of them in two large categories: 1) toxic smoke and 2) nicotine. The toxic smoke components contribute the general tissue damage and increased risks of cancer associated with smoking tobacco. Furthermore, two toxic substances, carbon monoxide, and hydrogen cyanide, have direct negative effects on the cells and cellular activities needed for wound healing. Nicotine also has a direct negative effect on wound healing by causing vasoconstriction, narrowing of the blood vessels. Thus, nicotine reduces the flow of blood to healing tissues depriving them of the oxygen and nutrients they require to rebuild and regrow.

Electronic cigarettes (aks: e-cigarettes or personal vaporizers) are high-tech elctro-mechanical devises designed to replicate the experience of smoking. They generate at a fine vapor or mist that is inhaled, just as smoke is inhaled. The vapor is created by heating a liquid within the e-cigarette that contains a variety of substances and chemicals. The liquid, and thus the vapor, do not contain the majority of the components found in cigarette tobacco that contribute to toxic smoke. The liquid does, however, contain variable quantities of nicotine. Recall that nicotine causes vasoconstriction of blood vessels headed to healing wounds following surgery.

How does this information apply to the issue of electronic cigarette use and cosmetic surgery? Should electronic cigarettes be avoided prior to elective cosmetic surgery just as traditional tobacco cigarettes use should be discontinued prior to and following surgery? Some point to electronic cigarettes as useful tool in the process of quitting tobacco use and site the absence of toxic smoke as an endorsement of increased safety. There are some in the medical community who stop way short of saying that electronic cigarette use is safe but speculate that it might be safer that tobacco smoking. These comments relate more to the effects on overall health and not directly to healing following surgery.

Electronic cigarette use is very recent phenomenon there is very little direct evidence that sheds light on the effect of electronic cigarette use and cosmetic surgery. To this point, as of June 16, 2013 there were only 3 “direct hits” found on a good search of “electronic cigarettes and wound healing” and only a handful when searching “electronic cigarettes and cosmetic surgery. The newness of electronic cigarettes aside, it is important to point out that The World Health Organization notes there are no rigorous, long-term studies that demonstrate the safety of electronic cigarettes. Given that electronic cigarettes contain nicotine, and nicotine causes a reduction in blood flow to healing wounds, it’s a reasonable hypothesis that there may be a negative effect on healing form cosmetic surgery. It is important to note, that most plastic surgeons regard the use of nicotine gum or patches as approximately, if not equally, harmful to the process of healing as cigarette smoking alone. That sentiment points to how powerful the negative affect of nicotine induced-vasoconstriction actually is on healing after surgery. Furthermore, early FDA analysis of electronic cigarette vapor demonstrated the presence of harmful and even cancer-related chemicals. The significance of these studies has been questioned by the electronic cigarette industry but it suggests the presence and quantities of these substances is worth further investigation.

So in summary, electronic cigarettes are an alternative to traditional tobacco cigarettes which deliver a nicotine containing vapor. The negative effect of nicotine on wound healing and related negative effect on safety and good results in cosmetic surgery is well established and know to be the result of reduced blood flow to healing tissues among other things. Thus, in absence of evidence to the contrary is is likely safest to consider electronic cigarette use should to be hazardous in relationship to cosmetic surgery and should be avoided for four weeks prior to and for a least two weeks following planned surgery. This article is for general educational purposes and should not be construed as direct medical advice. Consult with your plastic surgeon to inquire how you should address the use of electronic cigarettes and cosmetic surgery.


Adam Bryce Weinfeld, MD

June 16th, 2013

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