Dr. Nichter’s tummy tuck patient, Michelle 45 years old, shares her story with the American Society of Plastic Surgeons (ASPS) about her plastic surgery journey.
Dr. Larry Nichter explains how fat transfers can have the double benefit of reducing fat in unwanted areas and adding volume in desirable areas such as the buttocks.
Dr. Larry Nichter, regarded as one of the top plastic surgeons in Southern California, talks about why he decided to specialize in the field of plastic surgery and about his humanitarian efforts made possible through his Plasticos Foundation. To learn more about Plastics or to donate, please visit: http://www.theplasticosfoundation.org/
It is very difficult to determine the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 350 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. . Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in a bit.
Additional critical decisions will also be made by your plastic surgeon such as: whether your implants will be above or below your pectoralis muscle. These choices are recommended to you based on the look you desire, the amount of sagging you may have, and other deciding factors. For more than 25 years, I have tried just about every method to best understand and achieve the patient’s optimal goal. The following is what I have found to be most accurate: To start with, I have found it most helpful for patients to bring in photos from my or other plastic surgeons’ websites to illustrate what they would like to look like. This gives me detailed standardized views and information both qualitative (shape, perkiness) and qualitative (size) and allows me to discuss with my patients how I can best achieve their objectives as well as realistic expectations. For example, though I always tell my patients that I cannot make them exactly the same as a photo because everyone has different anatomical constraints. However, these ”ideal” breast photos are brought to the operating room for reference during surgery so that I have the advantage of “seeing through my patient’s eyes” to best achieve their wishes. Even if the photo does not match their height or weight, I and most plastic surgeons are very good at translating the proportionality of the photo to your features.
I personally order more than one set of implant sizes and use sterile implant “sizers” (temporary implants) placed in the created implant pocket during surgery to know in advance exactly which implant would work best for you in both a sitting and lying down position. This also allows me the opportunity to modify the pocket to meet some of the more subtle shape features desired. This enables me to use my full artistic potential to achieve your desired goals.
Larry S. Nichter, MD, MS, FACS
As you age, skin cells lose their ability to make collagen and progressively die off rather than reproducing themselves (“DNA programmed cell death with age”).The Sciton Laser Platform allows multiple laser types and wavelengths to achieve both dramatic improvements of your skin but also maintaining its youthful appearance by reversing this process.
Here are some of the incredible treatment options available:
Forever Young BBL (Broad Band Light) Optimally delivers and visible light of many wavelengths to the epidermis and dermis. This increases the lifespan and ability of skin cells to produce more collagen and elasticity similar to a more youthful cell by making changes at the DNA level. A Stanford University Groundbreaking Research Study, the first of its kind , demonstrated that BBL treatments can restore gene expression pattern of aged human skin to resemble young skin. Results: Over 1,000 gene expressions became “rejuvenated” to be more like youthful skin resulting in more elasticity and more uniform collagen deposition; leading to improvements in fine wrinkles and pigmentation. – This increases the lifespan and ability of skin cells to produce more collagen and elasticity similar to a more youthful cell by making changes at the DNA level. Clinically the skin looks and feels smoother and more youthful.
In addition to the BBL using the SkinTyte settings also Optimally delivers Infrared and visible light to the epidermis and dermis. Infrared light is used to heat the dermal collagen which responds by becomes thicker. This in turn reduces wrinkles and causes skin firming. Typically a series of treatments weeks apart give the best results and maintained with yearly treatments. The best news is that there is no down time and easily tolerated with by itself or with topical anesthetics.
Additional filters and adapters allow selection of specific frequencies of the broad band light to treat specific problem areas. For example the smaller wavelengths are great for acne, vascular and pigmented spots like broken capillaries and red spots, rosacea, sun and age spots where some of the longer wavelengths can be used for darker skin types. A built in special temperature controlled Thermoelectric cooling at the treatment area decreases discomfort greatly
Skin Tightening with Sciton® SkinTyte
SkinTyte is the newest Sciton laser technology to tighten and firm skin without downtime.
Common conditions that benefit from this therapy include:
- Sagging skin face jowls
- Smile lines
- Sagging skin on the neck, arms, abdomen, legs, and knee
SkinTyte is safe for all skin types and can be performed on any area of the body.
Frequently Asked Questions About Skin Tightening Laser Treatment
The Sciton SkinTyte system tightens the skin in the following manner:
The Sciton SkinTyte system delivers infrared light deep into the dermis. The heat from the special light:
- Causes the collagen and elastic fibers to shrink and thicken. This process stimulates the deeper tissues to remodel collagen. The remodeled collagen responds by filling in wrinkles and restoring elasticity to sagging skin.
The powerful cooling system maintains the outer surface of the skin at cool temperatures before, during, and after each pulse making the treatment comfortable and safe with no downtime. The SkinTyte technology can be applied anywhere on loose skin, from your face to your legs. The best results come in the face and neck area, especially the:
- Nasolabial folds
SkinTyte laser treatment can also help tighten and improve the appearance of loose skin on the:
It has proven beneficial in post pregnancy or after significant weight loss.
The Sciton SkinTyte system technology is FDA-approved and documented to be safer and more comfortable than the bulk heating approach of other systems because it is highly selective and more advanced in targeting collagen and elastic fibers in your loose skin.
Patients experience mild redness in the treated area immediately after treatment. This will last only a short time.
SkinTyte: Since the SkinTyte procedure is noninvasive, you can resume your normal activities immediately following treatment. There will be minimal discomfort during the SkinTyte laser procedure and topical anesthetics and local cooling will minimize any discomfort. The Sciton BBL hand piece has a large cooling sapphire crystal that keeps the skin cool and protects against discomfort. In addition, a range of energy and adjustments can be made to your comfort. The more energy you can tolerate, the better the results will be. During your treatment, there will be heat applied specifically to the dermal skin layer and you may feel a slight sunburn effect. Immediately afterwards, a tight feeling may be noticeable but no significant discomfort will be felt.
The SkinTyte system is the most advanced tissue tightening device available on the market today. A tightening effect will be visible immediately and skin will continue to firm throughout the month. A series of three to five treatments at four to six week intervals will deliver the most noticeable results of smoother, tighter skin. Improvements in the skin’s elasticity will continue over the next six months.
The Sciton MicroLaserPeel focuses on removing a thin layer of damaged skin to improve texture and provide a more youthful appearance. Being a laser it provides superior results by controlling precisely the depth of the laser. The procedure is performed our office and is custom tailored to your specific skin conditions and desired outcome with minimum down time.
Here is a synopsis of the procedure: The MicroLaserPeel’s beam is scanned over a treatment area to remove a very thin layer of the problematic skin. Removing the top layer eliminates some of the damaged cells that can give skin a tired, aged look. As the skin heals, fresh cells grow and resurface the treated area. This results in a healthier appearing skin, with reduced fine wrinkles and improved texture with color evenness. From tired looking skin to vibrant is the expected outcome. Depending on the depth of treatment the recovery time is usually 3-4 days (“week end peel”).
The following conditions can be treated with MicroLaserPeel:
- Mild wrinkles
- Keratosis (scaling lesions)
- Sun damage (e.g. sun/age spots, freckles)
- Pigment irregularities (dyschromias)
Most skin areas can be treated with the face, neck, chest and back of the hands most commonly treated. Your laser specialist will determine. under our Plastic Surgeon’s protocol, the best treatment choice and schedule for you to look your best. Both improvement and maintenance of your results will be discussed. These procedures can also be coupled with filler injections or Botox/Dysport if required or desired to complement your non-surgical rejuvenation.
Larry S. Nichter, MD, MS, FACS
Best Neck Line Improvement Requires Best Neck Lift Options and Best Plastic Surgeon
Neck Lift is a general term relating to procedures that will improve your neckline. There are many possibilities so picking the best neck lift treatment(s) for optimal improvement is most important. A board certified plastic surgeon with a special interest and substantial experience in neck lift and lower face lift surgery is the place to start. The reason for a plastic surgeon is that he/she can offer all possible options and tell you specifically which ones are best for you. Click here for tips on finding the best plastic surgeon.
The best recommendations to improve your neck appearance depend on your needs, desires, and most importantly an examination to determine the best procedure for you. Your plastic surgeon will evaluate you for five main features that will determine your best options for neck line improvement:
- Amount of excess fat typically found beneath the chin, and in the upper neck. This requires liposuction with small cannulas or direct removal especially if the fat is beneath the platysma muscle.
- Presence of Significant (Platysmal) Banding – this requires bringing the muscles together in the upper/mid neck to a more youthful position and occasionally their release. This procedure is called a platysmaplasty or platysma plication. Mild banding can be treated non- surgically with Botox or Dysport but this requires injections 3-4 times a year for maintenance.
- Amount of excess/redundant skin (cutis laxa) and condition of your skin. In advanced stages this is called a Turkey Waddle or Gobble deformity. For example, younger age, darker skin colors and no large weight loss history most likely means there will be better elasticity and therefore better post-surgical contraction. In milder cases if not too much fat is present there will be enough skin shrinkage with just lipo alone. Mild to minimal skin tightening using non-surgical means like the Sciton Laser SkinTyte procedure, Ultherapy or Thermage could also be considered. My personal preference for non-surgical skin tightening of the neck is the Sciton Laser BBL SkinTyte® procedure as there is no down time, more comfortable procdure, is effective and is a more targeted treatment. For redundant upper and mid excess neck skin: I prefer the LiteLift® (lower facelift ) procedure or MACS for skin re-draping for mild to moderate excess skin management as there are minimal scars and the skin is lifted vertically allowing for minimal hidden scars resulting in a natural appearance “non pulled” appearance. However: for moderate to severe skin redundancy , a neck lift or traditional lower facelift (e.g.Lite Lift®, MACS and others) is needed with or without lipo for best results. For advanced Turkey Waddle correction wither a traditional facelift or posterior neck lift often with a platysmaplasty is required with more extensive scars that extend at the hairline behind your ears. The advantage of a facelift procedure rather than a posterior neck lift is that your lower jawline (e.g. jowls and marionette lines) are also improved at the same time.
- Chin deficiency. If you have a weak chin then you will not have adequate chin support to your neckline skin which affects your entire neck line. Sometimes especially in younger individuals this is all that is required and this can be done in the office under local anesthesia. There are a number of different sizes and shapes and your plastic surgeon will pick the optimal one for you.
- Presence of prominent Digastric Muscles or Submandibular gland fullness from laxity or enlargement. Although not a major concern for most patients, if present then partial resection is usually the best solution.
In summary, picking the most qualified and best plastic surgeon with the most experience in neck improvement is essential to ensuring that you will have a wonderful and lasting result. It is the plastic surgeon’s ability to evaluate both your anatomical features and aesthetic goals to guide you to one or more neck lift procedures to give you the best neck line possible.
Larry Nichter, MD, MS, FACS
To look your best, see a plastic surgeon.
The Surgeons at Pacific Center for Plastic Surgery have combined efforts and created a medically based program for patients to look their best. Although many dermatologist are trained in ways to keep your skin looking the best it can, Plastic Surgeons have the unique ability to know the limitations of skin care and offer aesthetic surgical correction as needed to complement the improved texture, tone and color blending that skin care affords.
At Pacific Center for Plastic Surgery, we have developed a medical skin care program called BioSpa. BioSpa has the highest trained and experienced plastic surgeons, nurses, and medical aestheticians. Doctors Larry S. Nichter, MD, FACS and Jed H. Horowitz, MD, FACS are the medical directors of this program. Strict guidelines for care using physician approved protocols are crucial to providing efficacious and safe treatment outcomes. Our goal is to provide medical grade skin care in a spa setting in a safe manner with results not obtainable by non-medical aestheticians.
We are committed to becoming the gold standard exceeding patients’ expectations whenever possible. Our care and treatments are to be contrasted with the multitude of skin care programs that are not directly supervised by a Plastic Surgeon or Dermatologist and cannot use the prescription-strength products, injections, or lasers that we utilize. We work in concert with these centers rather than compete with them, and often refer our clients back to them for routine maintenance care such as facials or microdermabrasion.
When should an Aesthetician refer to a Medical Aesthetician working with Plastic Surgeons and Aesthetic Nurses?
Aestheticians and Medical Aestheticians need to work hand-in-hand to develop a successful skin care program. Each offers different levels of services. Identification of those conditions requiring advanced services or medical products are key to the success of this program.
Clients with the following conditions should be referred to a medical aesthetician:
- Hyperpigmentation and irregular pigmentation, age spots
- Acne and its complications – e.g. scarring, hyperpigmentation, and large pores
- Rhytides (Wrinkles) treatment
- Patients with medical conditions such as Diabetes, Exzema, history of cold sore, shingles, psoriasis, rosacea, or steroid use
- Scar Management
- Previous chemical peel or laser treatment
- Severe sun damage (actinic changes of the skin)
- Plateau of results by conventional spa services requiring more aggressive medical based protocols
- Patients with a history of Skin Cancer or pre-cancers ( e.g. Actinic Keratosis, pigmented sores, or scaling lesions)
The following constitutes some of the treatment tools restricted to Medical Aestheticians:
All products consisting of skin care lotions, ointments, liquids, substances, creams, powders, preparations, tonics, antiseptics, and other skin care items and products which the manufacturers or distributors will make available only to a physician or to persons who are working under the guidance of a physician as to their proper use. For example these include all products within the Obagi and / or Biomedic lines, as well as retinoids (e.g. RetinA), antiviral agents, 4% or greater hydroquinones, TCA, etc.
Medical procedures and use of medical equipment which must take place by physician protocol and/or oversight:
- Depth of Treatment as solo procedure with a non medical machine based on a more thorough treatment determined by number of passes or time per area; any procedure which requires recovery time because of redness (erythema).
- Medical Grade Machine, e.g., limited distribution to medical professionals, options for increased power settings, or medication delivery systems.
- Treatment of Patients with Medical Problems Acne, Roseacea, scars, stretch marks, non-uniform pigmentation (dyschromias), history of skin cancer, herpes, diabetes, hepatitis, HIV, previous laser or chemical peel prescription, etc.
- Non-medical grade microdermabrasion coupled with other treatments, e.g., glycolic, TCA, lactic acid or Jessner Peel, 4% hydroquinone, Oxymist, Dermaplaning, Micro Peel, Cryotherapy, etc.
- Chemical exfoliation (peels) within the scope of a cosmetologist’s license and affecting non-living tissue only, including Blue Peel, TCA peels and medical grade glycolic peels.
- Dermaplaning living tissue only per protocol.
- Laser treatments such Permanent Laser Hair reduction, IPL (photofacial) laser, vascular lasers (for broken capillaries or veins and red spots), color and scar improvement, and lasers for facial resurfacing.
- All injectibles such as Jeuvederm, Restylane, Sculptra, Radiesse, Voluma, Botox, lipoinjection (fat transfer). Surgical procedures.
Larry S. Nichter, MD, MS, FACS
Dr. Nichter explains the risks and effects of smoking prior to and during recovery after plastic surgery. Smoking — specifically nicotine and carbon monoxide — impedes the body’s ability to deliver oxygen to tissues. As a result, the healing process after plastic surgery is negatively affected. Healing after plastic surgery has a significant effect on the quality of your result.
Since the origin of its peer review survey of Best Plastic Surgeons, Orange County California plastic surgeon Dr. Larry Nichter has been named in the America’s Top Doctors publication, a listing of the top 1% of physicians in the United Statesfor seven years in a row.
The screening process for this highly exclusive honor is conducted by Castle Connolly Top Doctors®. The process first involves a peer nomination stage in which tens of thousands of physicians are recommended by their fellow doctors. Then, a physician-led research team at Castle Connolly conduct a review of candidates’ medical educations, honors, awards, board certifications, and disciplinary history. The result of their work is a listing of the best qualified doctors in the United States.
From Castle Connolly’s CEO, Dr. John Connolly:
Being selected for inclusion in America’s Top Doctors is a very significant achievement given to only 1% of American physicians. The world of American doctors includes incredibly high quality medical professionals, yet some stand out. Each year we evaluate tens of thousands of peer nominations from throughout the medical community. Then our experts go even deeper to evaluate and select Top Doctors based on referred doctors’ exceptional work and outstanding conduct. My congratulations to Dr. Nichter.
Dr Nichter has also been honored in peer selected awards such as Best Doctors, Top Doctors, and Super Doctors continuously since their start as well as patient selected awards like Compassionate Doctor and Patient Choice Awards , Dr. Larry Nichter continues to be recognized as an exceptional physician and one of the best plastic surgeons working in Orange County, Southern California today.
Breast implant maker Sientra has announced their Capsular Contracture Care Program, the first of its kind in the industry. The C3 Program provdes breast implant patients with a guarantee beyond the standard manufacturer’s warranty. From Sientra:
Under the C3 program, a primary augmentation patient will qualify for a free replacement implant if she requires revision surgery to correct Baker Grade III or IV capsular contracture within the first two years after implantation.
Capsular contracture is an unusual response of the body to medical implants, including all types of breast implants. It involves tightening of the tissues around the implant, which makes the breast feel firm to the touch and possibly alter its aesthetics.
Sientra’s TRUE Texture™ implants were found to carry a significantly reduced risk of capsular contracture compared to its smooth implants, according to a study published this month in Plastic and Reconstructive Surgery. The analysis looked at more than five thousand implants over a five-year follow up process, providing a very robust set of data as a foundation for this finding. It is with this statistical confidence in the resilience of their textured implants against capsular contracture that Sientra introduces the C3 Program.
As with the implants themselves, Sientra’s C3 Program is only available through plastic surgeons certified by the American Board of Plastic Surgery. This is done to improve patient confidence even further — it ensures that surgical procedures using Sientra implants are only done by the most qualified doctors.
Dr. Larry Nichter is proud to offer Sientra’s implants at the Pacific Center for Plastic Surgery, as well as the C3 Program and the warranty that comes with all Sientra implants.