Dr. Larry Nichter receives honor for his dedication to education on RealSelf, the world’s largest consumer source for cosmetic surgery information.
Newport Beach – Dr. Larry Nichter has been named one of 100 doctors to be included in the RealSelf 100, out of more than 5,000 Board-Certified plastic surgeons, dermatologists and licensed cosmetic dentists. The award from RealSelf, the world’s largest consumer source for cosmetic surgery information is granted to Dr. Nichter for his commitment to ensuring millions of consumers make informed decisions about cosmetic procedures.
Dr. Nichter is a plastic surgeon at the Pacific Center for Plastic Surgery in Orange County, California. He is one of few surgeons to be named in all three peer review publications: Top Doctors, Super Doctors, and Best Doctors. He is also Chairman of the Department of Plastic Surgery at Hoag Hospital, Newport Beach, and is the president and founder of the Plasticos Foundation.
Through participation on RealSelf, Dr. Nichter is helping prospective patients make confident decisions about cosmetic procedures they are researching. He has consistently earned top reviews from patients on RealSelf.com.
In addition, Dr. Nichter offers his professional expertise to the RealSelf community, having answered more than 1,600 questions for free since joining RealSelf last year.
Dr. Larry Nichter and the Plasticos Foundation have been featured in an article on the Boston University website.
The article highlighted Plasticos Foundation’s work in Laos, and in particular the story of a 14-year-old girl who was able to walk again thanks to the team’s efforts. Importantly, the article described how disfigurements and birth defects often lead to social exclusion. Thus the Plasticos team’s work improves not only the patient’s physical well-being but gives them a new life by providing them with social acceptance.
The featured trip was on January 2009, and provided 95 patients with much-needed reconstructive surgery. However, this is just one of many Plasticos missions. Previous and subsequent missions have included Cuba, India, Armenia, and Cambodia.
Also emphasized in the article was the Plasticos Foundation’s “teach a man to fish” philosophy. The team not only performs surgeries but also trains local doctors and nurses to continue this work even after the Plasticos team has left. Dr. Nichter is quoted in the article:
When I went back to Vietnam, for instance, I asked someone I trained three years previously how many cleft lips he had done, and he said, ‘Oh, about a thousand.’ He performed more in three years than I’ll probably do in my lifetime. That is humbling and gratifying.”
Women wanting breast augmentation have until now faced a dilemma: a choice between safer but less natural-feeling saline implants, and more natural-feeling silicone implants which are perceived to come with health risks.
The Ideal Implant®, a new breast implant soon to be made available to the public, promises to change all of this. The Ideal Breast Implant is a saline implant with the natural feel of a silicone implant made possible by its innovative double-lumen design. This design consists of a series of nested shells which control the flow of liquid inside the implants, giving them a more realistic feel than standard saline implants.
The Ideal Implant has completed its two-year trials with stunning results. Of the 472 women who came in for two-year follow-up examinations, patient satisfaction for those who received the Ideal Implant as their first implants was 94.3%. Satisfaction among women who received Ideal Implants as replacements for their previous ones was 92.3%. Surgeon satisfaction with the results was also high (96.5% for primary implants and 93.4% for replacements).
Dr. Larry Nichter, one of the surgeons assessing the new implants for the FDA, comments very favorably on the new breast implants in a press release by the American Society for Aesthetic Plastic Surgery:
“The two-year clinical data from this study show that the Ideal Implant may provide a good alternative to current saline- or even silicone gel-filled implants. One of our most significant and unexpected findings was the low rate of capsular contracture for the investigational, double-lumen implant compared to current single-lumen saline implants.”
The Ideal Implant’s two-year statistics for capsular contracture were better than those for regular saline implants at one year, and none of the small number of deflations were caused by shell fold flaws.
As a further guarantee of quality and safety, the Ideal Implant will only be available through plastic surgeons who are certified by the American Board of Plastic Surgery, which is the only plastic surgery board recognized by the American Board of Medical Specialties. This means that women who choose the Ideal Implant will automatically be choosing from among the best plastic surgeons in the United States.
To receive updates about the ideal implant or to be placed on Dr. Nichter’s waiting list for the procedure, please contact our office using the form below.
“Two-Year Outcomes With a Novel, Double-Lumen, Saline-Filled Breast Implant”
Originally published by the American Society for Aesthetic Plastic Surgery, Inc.
Click on the thumbnail to download this article as a PDF.
Abstract
Background: A double-lumen, saline-filled breast implant with a baffle structure (IDEAL IMPLANT Saline-Filled Breast Implant; Ideal Implant Incorporated, Irving, Texas) was developed to overcome the limitations of single-lumen saline implants by controlling saline movement and providing internal support to the implant edge and upper pole.
Objective: The authors report 2-year data from a 10-year US clinical trial evaluating the safety and effectiveness of this investigational implant.
Methods: Women seeking primary breast augmentation or replacement of existing augmentation implants were enrolled between February 2009 and February 2010 at 35 private practice sites, where the women underwent surgery to receive the new technology implant. Data collection included incidence and grade of capsular contracture (CC) and wrinkling as well as patient- and surgeon-reported satisfaction measures. All clinical data were reported as Kaplan-Meier risk rates of first occurrence, per patient, in each cohort.
Results: Two-year follow-up visits were completed by 472 of 502 enrolled women (94.0%), 378 of whom had undergone primary breast augmentation and 94 of whom had received replacement augmentation. Patient-reported satisfaction with the outcome was 94.3% for primary augmentations and 92.3% for replacement augmentations; surgeon-reported satisfaction was also high (96.5% and 93.4%, respectively). Baker Grade III and IV CC rates were 3.8% (primary) and 8.2% (replacement), whereas moderate-to-severe wrinkling was 3.8% (primary) and 12.0% (replacement). Deflations occurred in
4.8% of primary augmentations and 3.3% of replacement augmentations. No deflations were caused by a shell fold flaw.
Conclusions: Two-year data from 472 women indicate that this double-lumen saline implant containing a baffle structure has a low rate of wrinkling and a lower rate of CC at 2 years than was reported for current single-lumen saline implants at 1 year.
Although saline-filled implants are a safe, effective alternative to silicone gel-filled implants,1 the currently available saline-filled implants are essentially balloons filled with freely-moving fluid, which may result in an unnatural feel or suboptimal aesthetic result.2-5 These implants, which have only a single lumen, tend to be less forgiving than silicone gel implants in terms of palpability, visibility, and rippling.5,6 Scalloping or wrinkling, for example, is a well known problem.5-7 This may be a significant part of the reason that 31% of women in the United States chose saline-filled implants for breast augmentation in 2011.8 For a more natural result, the only currently available alternatives to saline-filled implants are silicone gel-filled implants, which some women will not accept. Clearly, there is a need for a saline-filled implant that offers a more natural result, without the wrinkling, bouncing, or globular shape commonly attributed to current saline implants.2-5Continue reading “IDEAL Structured Breast IMPLANT®: 2-year Follow-up Study Results”→
Dr. Nichter is pleased to announce that the long-lasting local anesthetic Exparel® will soon be available to his patients at the Pacific Center for Plastic Surgery.
Essentially Exparel is a very long-acting local anesthetic that has just been released. It lasts approximately 3 or more days following injection. This is the same length of time that a pain pump lasts and will therefore take the place of a pain pump. This means patients can enjoy the same effect of a pain pump, but without any catheters and no pain pump to carry around.
Exparel will be available for those concerned about minimizing discomfort after surgeries such as tummy tuck and breast augmentation.
Exparel costs the same as a pain pump and produces the same result but with less hassle.
To help control your pain after surgery, your surgeon injected EXPAREL into your surgical incision just before the end of the procedure.
EXPAREL is a local analgesic that contains the local anesthetic bupivacaine. Local anesthetics provide pain relief by numbing the tissue around the surgical site.
EXPAREL is specifically designed to release pain medication over time and can control pain for up to 72 hours.
In addition to EXPAREL, your surgeon may provide other pain medications to control your pain.
Each patient is different and responds differently to pain medication. Depending on how you respond to EXPAREL, you may require less additional pain medication during your recovery.
[…]
When your pain is under control, your body can better focus on healing. This is not the time to test your pain tolerance, or grin and bear it.Work with your surgeon and nurse to make your recovery as speedy and pain-free as possible.
Follow the post-op orders your nurse gave you.
Eat a healthy diet and drink plenty of water. Surgery stresses your body; your body responds by needing more energy to heal
Dr. Larry Nichter would like to share this video update from the American Society of Plastic Surgeons (ASPS) with his readers. The ASPS is an exclusive society of board-certified plastic surgeons and a trusted source of information about plastic surgery.
Highlights include:
Men are seeking laser procedures to lighten stretch marks after weight loss. ASPS’ data indicate that more men are seeking cosmetic procedures; 1.2 million procedures were done on men last year, up 6% from the previous year.
Brides-to-be are also seeking to perfect their look before the big day, with Latisse Eyelash Extension leading the trends, followed by Botox, Microdermabrasion, dermal fillers, and cool sculpting.
A new device which melts fat away with ultrasound has gained FDA approval. This non-invasive fat-reduction technique is effective for certain patients, but is not a substitute for real liposuction.
Use Clonidine Patches as directed by your doctor. Check the label on the medicine for exact dosing instructions.
You will apply the patch to a hairless area on the upper outer arm as directed by our office.
If your blood pressure is normal, it is usually applied two days prior to surgery and left on for one week. If directed to use one prior to that, it should be changed in 7 days if applicable. The area chosen should be free of cuts, scrapes, irritation, scars, and calluses. Do not place the patch on skin folds or under tight undergarments because it may come loose. If more than one patch is prescribed then the new patch should be placed on a different skin site from the previous site.
Wash your hands with soap and water and dry them completely before applying Clonidine Patches.
Clean the chosen application area with soap and water. Rinse the area and wipe it with a clean, dry tissue.
Remove the patch from the pouch. Remove the clear plastic protective backing from the pouch by gently peeling off one half of the backing at a time. Avoid touching the sticky side of the patch.
Place the patch on the skin site (sticky side down) by applying firm pressure on top of the patch. The adhesive overlay does not contain any medicine and should not be used alone.
Wash your hands with soap and water to remove any medication that may be on your hands.
If the patch does not stick firmly or begins to come loose, apply the adhesive overlay on top of the patch. The adhesive overlay does not contain any medicine and should not be used alone.
After removing the used patch, fold it in half with the sticky sides together. Discard the patch out of the reach of children and away from pets. Even after it has been used, the patch contains active medicine, which may be harmful if accidentally applied or ingested.
Continue to use Clonidine Patches even if you feel well.
Best Scar Management is important to minimize or completely hide from view, the telltale signs of your surgery—namely, scars. Both you and your surgeon want you to have the most minimal scarring possible. There are many possible causes for scars that are enlarged or not healing well. Unsightly scars are most commonly due to genetics, underlying medical conditions, or improper scar/wound care. The last part is very important and patients can make a noticeable difference in their scars’ appearance by following best scar management practices. Here are some simple tips.
Scar Management tips:
Minimize tension on the scar. Steri-Strips and/or surgical tape are often placed in non-hair bearing areas at the time of surgery to minimize tension and keep pressure over the scar. This minimizes the stress that can pull the scar apart (dehiscence) creating a wound and delaying healing time, and can make the scar wider, or more “ropy”. In the first few weeks after surgery, I recommend the use of Embrace Scar Therapy which is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar.
Keep your incision site/scar clean to prevent infection. Follow your surgeon’s wound care instructions to the letter with out modification. Never apply different products then recommended without first discussing them with your surgeon. This is especially important during the first few weeks. If there are any signs of infection, contact your surgeon’s office right away and/or see your doctor or his nurse immediately. Typical signs of infection may include redness outside the immediate incision site, asymmetric swelling, and drainage, of pus, fever, chills, and “feeling sick”.
Protect your scars from the sun. Staying out of the sun is the best advice. Minimal exposure to sunlight is prevents hyperpigmentation (permanently turning brown) and other problems that can make the scar more noticeable. Sunscreen, at least 30 SPF and an overlying make camouflage make up additionally protects the scar from the suns harmful rays. This advice is especially important the first year following your surgery.
Use specific scar maturation products recommended by your surgeon. Patients seem to have their own opinions on this touting everything from Pure Vit E, Coco butter, to Aloe Vera, etc but most have minimal benefit other than keeping the scar hydrated. Although hydration is important there are better, scientifically studied products with greater efficacy. Most of the scientific articles written about this subject indicate that topical silicone gel or silicone sheets work the best. The best product available in my opinion is the Embrace Scar Therapy System by Neodyne BioSciences, Inc. available in many surgeons’ offices. Essentially this is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar. For areas that are not applicable for this product (e.g. smaller areas or on the face), I prefer BioCorneum or Kelo-Cote products There are a lot of products to choose from, but silicone should be one of the key ingredients. Although Mederma, an onion extract derivative active ingredient rather than mainly silicone based may help, primarily silicone based products are better and many also contain other ingredients that may be synergistic (hydrocortisone or other steroid, Vitamin E, Sunscreen, etc).. If the reader has problems obtaining these they can call my office. Patient compliance is also critical – use often and according to directions or it will not work optimally. NEVER apply products without first discussing them with your surgeon.
Monitor to make sure your scar is progressing optimally. Keep your scheduled follow-up appointments with your surgeon to verify that your scars are maturing as expected. Occasionally if indicated you may need a topical steroid preparation or even a series of injections (5-FU and/or Steroids) or laser treatments to treat or prevent scar hypertrophy or keloid formation (red raised scars), or other topical medicines to treat post inflammatory hyperpigmentation (brown scars) with prescription creams and possible laser treatments.
The most critical decision to be made in achieving the best plastic surgical result is picking the most experienced and talented, that is the best, plastic surgeon possible. Too often, patients choose a physician based on a catchy ad, the brand name of a technique, the basis of one or two before and after photos, or their web site’s search engine ranking. These criteria will not find the most experienced and talented plastic surgeon.
My Background
Dr. Larry Nichter
I have been a practicing plastic surgeon for more than 25 years, having trained scores of plastic surgeons as a tenured professor of plastic surgery at USC, and I have had a private practice in Orange County since 1993. Speaking from all this experience, here is my advice and the criteria I would use to find the best plastic surgeon in Orange County, Los Angeles, California, or anywhere in the United States. These are the criteria I would use to select a plastic surgeon for my friends, my family, or myself.
First, I want to stress some general observations I have found to be true over the years.
Caveat Emptor: Buyer Beware
The longer a surgeon trains at his craft, the finer his skills and the better his judgment become. Board certification in Plastic Surgery (see below) is a bare minimum. Board certification in an additional surgical field recognized by the American Board of Medical Specialties, or for that matter “triple-board certified,” attests to a doctor’s advanced training and skill and judgment. It also means that they have attained Chief Resident Status in more than one field during their training which means they essentially ran a large departmental service and had senior decision-making and independent operating responsibilities. It is this step that is most maturing for a surgeon.
The institution where the surgeon trained is also important. More renowned schools usually attract the best faculty.
You can use the internet to research the background of a prospective plastic surgeon quickly. Please do this prior to making an appointment. “Just because you wear a baseball cap it doesn’t mean you are a good ball player.” The same applies to anyone wearing a white coat—it doesn’t make you a plastic surgeon, much less a great one.
Caveat Emptor in Latin means “Buyer Beware.” In most states, including California, any physician with a medical school diploma and state license is viewed as a doctor and a surgeon—even without any formal surgical training. In some cases even doctors who have completed only the minimal requirements (medical school, licensing examination, and a one-year internship that need not include surgical training) are touting themselves as “cosmetic surgical experts.” They make these claims of expertise despite the fact that they are only formally trained as family practitioners, OB/Gyns, emergency physicians, dermatologists, or ear-nose-throat specialists. Even physician assistants and nurses have made such claims.
7-Step Process for Finding the Best Plastic Surgeon
The following are my screening guidelines and criteria for picking the best plastic/cosmetic surgeon.
1. Board Certified Plastic Surgeon by the American Board of Plastic Surgery
To become a plastic surgeon certified by the American Board of Plastic Surgery requires a minimum of five years of surgical training with a minimum of two years of training specifically in plastic surgery. Then the applicant must also pass a comprehensive written board exam. If successful, the candidate must present his/her clinical cases for critical review by board examiners (I was one such board examiner) and if accepted will take a series of oral examinations.
Since the 1990s, the American Board of Plastic Surgery Certification is only valid for ten years. To retain your board certified status, a plastic surgeon must complete a Maintenance of Certification including written testing and case review. This means that all who pass are trained and experienced in all plastic surgery procedures including facial procedures, breast, and body; essentially all cosmetic and reconstructive procedures.
If a Plastic Surgeon is additionally board certified by another surgical specialty recognized the American Board of Medical Specialties, then this also marks additional expertise and training at the highest level. The American Board of Facial Plastic Surgery (ABFRS) is not a licensing body nor an educational institution and the certificates it issues are not legal licenses to practice facial plastic and reconstructive surgery. The ABFRS is not recognized by the American Board of Medical Specialties (although it does note additional specialty training/interest in facial aesthetic surgery).
Likewise, beware of physicians armed only with certification from other non-ABMS recognized boards or special society memberships other than those I have recommended (eg. “Cosmetic Surgery Board,” “Lipoplasty Society of North America,” etc.).
2. Fellow of the American College of Surgeons: FACS
The American College of Surgeons is dedicated to improving the care of the patient and to safeguarding standards of care in an optimal and ethical practice environment. Members of the American College of Surgeons are referred to as “Fellows.” The letters FACS (Fellow, American College of Surgeons) after a surgeon’s name mean that the surgeon’s education and training, professional qualifications, surgical competence, and ethical conduct have passed a rigorous evaluation, and have been found to be consistent with the high standards established and demanded by the College.
To be a member you have to:
be board certified in a surgical specialty recognized by the American Board of Medical Specialties
be in practice in one location for a number of years, with a background check, nomination, and interviews which verify that you are an ethical and safe surgeon among other criteria.
Hint: Look for the “FACS” (or “FRCS,” see below) after the “MD” in a doctor’s title or in his/her Curriculum Vitae to see if he/she is a “real surgeon.”
Note for patients in Canada: The equivalent of FACS in Canada is the Royal College of Physicians and Surgeons of Canada, FRCS.
3. Member of the American Society of Plastic Surgeons (ASPS)
The American Society of Plastic Surgeons is the largest organization of plastic surgeons in the United States and one of the largest in the world. ASPS members are uniquely qualified because of the society’s membership requirements:
Members of the American Society of Plastic Surgeons must be Board Certified by The American Board of Plastic Surgery complete at least 5 years of surgical training with a minimum of 2 years of training specifically in plastic surgery. The more years of Plastic Surgical Training the better – this includes fellowships in a plastic surgical field.
American Society of Plastic Surgeons members are required to adhere to a strict code of ethics and must fulfill rigorous Continuing Medical Education (CME) requirements including patient safety issues.
Beware of physicians without this membership but belonging only to similar-sounding societies as their claim to excellence eg. “American Society of Cosmetic Surgery,” “Lipoplasty Society of North America,” etc.
4. Member of the American Society for Aesthetic Plastic Surgery (ASAPS)
This is the most elite society in the United States and perhaps the world for Aesthetic Plastic Surgery. To be a member means that your career is focused in cosmetic surgery at the highest level. Among the requirements for invitation and election to ASAPS membership, a plastic surgeon must:
Be certified by the American Board of Plastic Surgery (or in plastic surgery by the Royal College of Physicians and Surgeons of Canada);
Be in at least the third year of active practice following board certification;
Participate in accredited Continuing Medical Education (CME) to stay current with developments in the field of cosmetic plastic surgery and patient safety;
Document the performance of a significant number and variety of cosmetic surgical cases to demonstrate wide experience;
Be sponsored by two ASAPS-member plastic surgeons to help ensure that the applicant’s professional reputation meets the high standards required by ASAPS;
Adhere to current ethical standards for professional conduct as outlined in the Code of Ethics observed by all ASAPS-member surgeons;
Operate in accredited surgical facilities; and
Be elected by at least 80% of the Active Membership.
5. Hospital privileges to perform the same type of surgery
Hospitals often examine qualifications of doctors applying for hospital staff privileges and restrict privileges to only surgeons best trained and qualified to do certain procedures. For example, in order for surgeons to be granted plastic surgery privileges in most hospitals in Orange County, California, that surgeon must have completed plastic surgery residency training and must be board-eligible or -certified in plastic surgery to be allowed to perform plastic surgical operations in that hospital.
Non-surgeons and other physicians that are not plastic surgeons circumvent this process by performing surgery in their offices or in outpatient surgery centers where the credentialing process is less rigorous or nonexistent. In these settings non-plastic surgeons perform procedures in which they have no formal residency training.
I am not warning against use of outpatient surgery centers or in-office procedures. I am only recommending that you check that your physician has hospital privileges for these same procedures.
6. Surgical Experience in the procedure you are having
Few patients ask how long doctors have been doing a certain procedure or how many they have performed. When you consult with a plastic surgeon:
Ask to see typical “before and after” photos;
discuss the details of the procedure in a manner that is clear to you;
review benefits and potential complications;
get full answers to your questions.
7. Evidence of Excellence, Experience and Commitment to the field of Plastic Surgery
Here are some additional criteria to look for in your plastic surgeon.
Surgical Board Certification in more than one field
Plastic Surgical Fellowships in addition to Plastic Surgical Residency.
Number of years practicing.
Peer Review Honors in their own board certification from groups such as Best Doctors, Top Doctors, Super Doctors.
Current or Prior position denoting excellence in the field or high regard by their peers such as:
Prior or present Professor or Faculty affiliation with a University Plastic surgical program (the higher the rank the better)
Chairman of a Department of plastic surgery at a regional hospital
Honors from surgical societies of which they are members such as Board Examiner, etc.
Published Plastic Surgical papers in peer review journals are also a good sign that they are committed to being on top of their field.
Feel Comfortable with your choice
It is very important that after you have done this screening and met with your potential surgeon that you feel confident in your choice.
Complications are not common in cosmetic surgery, but if one did occur are you confident that this surgeon would take charge and handle just about any problem?
Do you feel that he listens to you and communicates well by answering your questions completely, doesn’t rush you in to a decision but rather makes you part of the decision-making process? You should truly feel that it is a combined effort.
Does the surgeon’s office run smoothly? Do the staff take good care of you? If you answered in the affirmative and have gotten this far in your screening guidelines then I think you have found your “Dr. Right.”
A compression garment is required and beneficial after liposuction because:
It restricts the amount of edema that forms and hastens its resolution by mechanical pressure.
It decreases the amount of bruising.
It assists the loose skin in retracting or shrinking.
It is common to have weight gain due to edema, serum that collects in the area, and the tumescent fluid that was injected. This will resolve over time. The more you wear the garment initially, the quicker this fluid resolves.
Edema: a condition characterized by an excess of watery fluid collecting in the cavities or tissues of the body.
The length of time that the garment should be worn varies depending on the amount of fat removed, the elastic nature of your skin, how much loose skin remains, and other factors. Your surgeon would give you the best advice, however this is the general routine for my patients.
The first garment should be fitted for you in the office prior to surgery and applied in the operating room. Often it will become loose as the edema is mobilized, and then it will need to be replaced. Spanx is a reasonable compression garment if it gives enough support and is the right size. I have my patents bring them in so I can confirm that it fits well.
Most important advice is to listen to your surgeon, as he or she knows how much fat was removed, the elasticity that remains in your skin, and amount of skin redundancy.
I recommend that my patients wear their garments for a minimum of three weeks full time then for twelve hours at a time (day or night). If there is not a lot of redundant skin, this continues to a maximum of six weeks.
To be effective, the garment needs to fit snugly—but not too tight as that can make it difficult to sleep or cause pressure problems (inspect your skin when it is exposed if you are uncomfortable). As the edema resolves it is common for patients to switch to a smaller garment that fits. A Spanx-type garment would work fine, rather than ordering one or paying more at your doctor’s office.
Dr. Larry Nichter receives honor for his dedication to education on RealSelf, the world’s largest consumer source for cosmetic surgery information.
Women wanting breast augmentation have until now faced a dilemma: a choice between safer but less natural-feeling saline implants, and more natural-feeling silicone implants which are perceived to come with health risks.
“The two-year clinical data from this study show that the Ideal Implant may provide a good alternative to current saline- or even silicone gel-filled implants. One of our most significant and unexpected findings was the low rate of capsular contracture for the investigational, double-lumen implant compared to current single-lumen saline implants.”
