Cosmetic Surgery Center, Dallas | Dr. Rai

Gynecomastia is enlarged male breasts, where the extra tissue is glandular rather than just excess fat. A number of general causes have been identified, but in any individual case, the specific cause cannot always be determined. In two groups of people the cause is typically clear:

• In newborn babies it is caused by the mother's estrogen temporarily being in the baby's bloodstream
• In teenage boys the cause is hormonal changes during puberty

It can also occur in adult males, usually mid-life to older males, because aging testes produce gradually less and less testosterone.

Other Causes

• Heredity
• Lack of testosterone and/or excess estrogen
• A tumor which produces estrogen
• Some medications such as steroids, epilepsy drugs, and some heart drugs
• Chemotherapy drugs
• Antidepressants such as Valium
• Products which contain tea tree oil or lavender oil

Diagnosis

Typically gynecomastia can be diagnosed through a physical examination and medical history. If the tissue is particularly large or hard, one-sided or tender, a tissue sample (biopsy) till be taken to test for other potential problems. Cancer will be considered if there is a family history of cancer.

Treatments

In babies and adolescents, gynecomastia usually subsides by itself. If the cause is determined to be a particular medication, stopping that medication will take care of it, although another drug may then be prescribed if necessary. If it is caused by hormonal imbalance, hormonal treatment will be effective.

Gynecomastia consisting of excess fatty tissue is technically called pseudogynecomastia and is easily treated by cosmetic surgery. Dr. Rai offers this male breast reduction using ultrasonic liposuction in an outpatient procedure.

If you would like more information about this procedure, please call or email our office today for a personal consultation.

One of the complications that sometimes happens after breast augmentation is capsular contraction. Any time the body detects a foreign object it builds a membrane of connective tissue (collagen and elastin) around it as a kind of protection. It is a way of connecting the natural body tissue to the implant.

In the case of breast implants, this is usually not a problem, as the membrane simply surrounds the implant and contains it.

Sometimes the connective tissue (often called "scar tissue") is built up too thickly and starts to contract. It can squeeze the implant, making it too hard and causing pain, and this is known as capsular contracture. It is a type of inflammatory reaction.

Several countries, such as Germany and Australia, have been conducting tests on a new type of implant. It is coated in titanium, a biocompatible metal. There is strong affinity between body tissue and titanium. Dental implants are made of titanium because the jawbone accepts their presence and grows closely in around them. This makes them strong anchors for artificial teeth to replace missing teeth.

A titanium coating over a breast implant has several potential advantages:

• It may be more resistant to infection
• It may make the implant stronger
• It may discourage excess "scarring" around the implant

The result would be a calmer and more certain recovery period and more natural-looking breasts. The collagen and elastin membrane would give a smoother appearance.

Titanium-coated breast implants are still in the testing phase worldwide. Until testing is concluded no definite prognosis can be made of success. In the meantime, we offer both saline and silicone gel breast implants. We invite you to call or email our office if you would like to schedule a personal consultation.

At the upcoming annual meeting of the American Society of Plastic Surgeons (ASPS) in Chicago, a group of surgeons are planning a presentation about using fat injections (also called fat grafts) for breast augmentation. They were chosen earlier as a task force to study fat injections for this use.

Fat injections have been used for years as part of breast reconstruction after a mastectomy. But they are new to cosmetic use and there is not a lot of research on their effectiveness or safety.

The ASPS task force is reported to be stopping short of recommending fat grafts for augmentation, instead suggesting that they be tried. They are known to be effective in softening the appearance of implants but not as breast augmentation by themselves. There is also some concern about them interfering with detection of breast cancer.

ASPS Task Force Findings

After studying 110 published studies, the plastic surgeons have concluded that:

• Fat grafts can be used for reconstruction of breasts, hands, and face, and for cosmetic breast augmentation, but there are no standardized techniques
• For lack of sufficient data, no specific recommendations can be made about their use in breast augmentation
• There is so far no increased risk of breast cancer connected with fat grafts
• Data suggests fat grafts may interfere with breast exams but not with mammograms
• More studies are needed
  

Two Trials Recruiting Volunteers

Two clinical trials are now seeking women volunteers for fat graft breast enlargement.

• One is seeking just 20 women aged 20 to 50 to have liposuction for obtaining fat to use in fat grafts for the breasts.
• The other is planning to use fat grafts in conjunction with the Brava system of breast enhancement, which is a method of stimulating the natural breast tissue to grow. It uses special domes worn over the breasts for a few hours each day

At the Cosmetic Surgical Center we offer more established breast augmentation procedures which have been thoroughly tested and proved. Well-planned implants will give you a predictable result based on your goals, for far less cost than augmentation through fat injections.

To learn more about breast implants, please see our pages on Breast Augmentation Surgery Options. If you would like a consultation with Dr. Rai, please contact our office today.

A fashionable woman loves fashionable shoes and will wear high heels all day every day. Now a new health problem is emerging called StilettoTarsal. From putting so much relative weight on the balls of their feet for years, some women now have chronic inflammation.

To get this treated, they are seeking dermal fillers in their feet in a procedure called the Foot Filler. By plumping up the balls of their feet, these injections protect the nerves and soft tissue so women can continue teetering fashionably along the pavements of Europe and Britain.

Other stiletto-caused problems are corns, bunions, blisters, deformed toes, flat feet, and even knee, hip and back problems. None of this discourages fashion designers, who have made five-inch heels popular in Britain and have just announced a new eight-inch heel.

Nor does it discourage women who look to their sexy shoes for self-esteem.

• One young accountant in London is scheduled for an expensive three-hour procedure to shorten her toes, remove corns and straighten some of her toes. 'I know it sounds extreme,' she said. 'And the operation does scare me a little, as I don't like the thought of, perhaps, not being able to walk for up to six months afterwards, but for me, it really is a price worth paying for pretty feet.'
• A young design assistant in London has bunions and knee problems after ten years of wearing high heels for 18 hours each day for her work. She can no longer get her shoes on at all, although she owns hundreds of pairs of stilettos, platforms and wedges. Her planned surgery is too expensive for her, but she says, 'I'm desperate for the operation and hopefully I'll have it soon. I can't bear that I can't wear my stilettoes at the moment, I just don't feel sexy without them.'

Other women are having cosmetic surgery to narrow their feet or lengthen their toes, back operations and knee surgery -- anything to avoid having to wear trainers. 'My doctor has warned me,' said one, 'That I risk doing myself permanent damage, but I tried wearing trainers for a while and I felt ugly. So I'll just have to grit my teeth through the pain.'

At Cosmetic Surgical Center we counsel moderation and common sense. While many cosmetic surgeries can indeed raise self-esteem and improve physical appearance in a healthy way, it would appear that each person must draw a line somewhere and accept what nature has given them.

If you would like more information about cosmetic procedures we offer, such as injectable fillers, breast augmentation or liposuction, please contact our office for a personal consultation.

Botox has become immensely popular worldwide and it seems that its popularity might be going too far. The U.K.'s largest cosmetic surgery provider is the Harley Medical Group with 23 clinics scattered throughout the U.K. and Ireland. Recently they have announced that their cosmetic surgeons are trying to reduce Botox use by recommending smaller doses and in some cases turning patients away who do not need any Botox Treatments.

The new word for people going overboard on Botox is Wrinklerexia. It is presumably based on the term Anorexia for a person's compulsion to avoid food in the interests of becoming slim, but actually eating so little that they become gaunt and weak, and sometimes have to be hospitalized to restore their health.

There have been similar reports in the U.S., of women having so much Botox injected into their faces that they get a frozen look -- what is being called a "freeze-frame" face. Perhaps this is similar to the early facelifts which created a "windswept" look because the cosmetic surgeons in those years were overcorrecting the signs of aging. Now perhaps some patients are demanding "overcorrection".

How Botox Works

Botox is not an injectable filler like the popular Restylane, Radiesse, and Sculptra (all of which we offer). It temporarily paralyzes the muscle into which it is injected -- most often muscles in the forehead to smooth out frown lines and horizontal wrinkles. It can also be used to treat wrinkles around the mouth and in the neck.

It blocks the nerve messages coming from the brain telling those muscles to contract -- messages like "Frown!" and "Squint!" The muscles therefore remain relaxed and the skin looks smoother. Repeat treatments have a progressive effect whereby the existing wrinkles diminish through not being reinforced by regular frowning or scowling.

Baby Botox

In response to the excessive patient demand for Botox, the Harley Medical Group cosmetic surgeons have responded with use of smaller doses -- Baby Botox. They are trying to maintain a natural look and these lower doses make a more subtle difference. The philosophy is that a Botox treatment should not be obvious.

A still photograph might not show any frozen look but the face is always in motion. We are continually moving our facial muscles in eating, conversations, joking, responding to events around us, lighting conditions, what other people say etc. When certain muscles are not contributing to the overall facial expressions the face could certainly have a frozen look and might raise a question as to the person's mental or emotional status.

If you would like to know more about how best to reduce the signs of aging on your face, please call or email the Cosmetic Surgical Center for a free consultation. We will be happy to answer your questions and make some recommendations.

Tummy tucks can be done with an endoscope to make them less invasive and easier to recover from. When you talk to Dr. Rai you can ask about having your tummy tuck done this way. It can be done if you are close to your ideal weight, have elasticity in your skin, and have only mild stretching or separation of the abdominal muscles.

What is an endoscope?

An endoscope is a tiny camera on the tip of a narrow tube. The tube can be inserted through a small incision and maneuvered beneath the skin. With the camera is a tiny light enabling the camera to send images to its computer. The tube has a channel through which surgical instruments can be inserted.

On the computer monitor, Dr. Rai can see magnified images of where the endoscope is, what needs to be done, and what he is actually doing. He will be able to tighten and suture the abdominal muscles through very small incisions.

Advantages of an endoscopic procedure

• Small incisions -- A traditional tummy tuck makes a long incision from hip to hip along the bikini line. Because the endoscope tube is narrow, only very small incisions are needed in an endoscopic procedure – about 3 millimeters. Several would be used.
• Less visible scarring -- Small incisions mean small scars and these will be well hidden at the pubis and inside the navel
• Less bruising -- Smaller incisions mean less trauma to the skin and tissue
• Less bleeding -- Smaller incisions cause less bleeding
• Faster recovery -- You can return to daily activities within a week or two, depending on the amount of work done and your body’s healing speed

To learn more about endoscopic tummy tucks and to have your questions answered, please call or email our office to arrange a personal consultation.

New York City now has a Manhattan walk-in BOTOX clinic where you can pop in on your lunch hour after you pick up your sandwich and coffee and rejuvenate your face. No appointment is necessary and no pre-treatment consultation. It's called "SmoothMed: BOTOX Cosmetic on the Go" and is a short walk from Bloomingdales.

It is owned by a plastic surgeon named Michael Rose, who describes its purpose as "to get you in and out in 30 minutes or less". He does not see why you should spend "your whole day just to get a five-minute BOTOX shot".

Objections have been raised by other medical professionals, but Dr. Rose claims that he is not taking any risks with medical protocol, just with the consumer's time. Only physicians are giving the injections, emergency equipment is at hand, and all the required precautions are being taken.

At the Cosmetic Surgical Center we offer BOTOX Cosmetic, and it is indeed a brief procedure, taking about ten minutes. We do prefer to have some discussion with you beforehand however. BOTOX injections are not the only way to smooth out facial wrinkles, and in your individual case there might be a better option.

We would like to know more about you and your goals and concerns before going ahead with any cosmetic rejuvenation. We would want to answer all your questions and know that you feel comfortable and at home in our facility, and that you have full confidence in Dr. Rai and our team.

To learn more about BOTOX and other ways of rejuvenating the skin, please call or email our office today.

As Argentina's peso currency sinks against the dollar and euro, fewer people have been frequenting the many dance halls and clubs. So some club owners have devised some creative ways of attracting more customers.

"Breast raffles have been drawing thousands of people, mostly young women, and the young women draw the young men. Argentina has one of the highest plastic surgery rates in the world and as cosmetic surgery tourism continues to grow, many are choosing Argentina for their procedures.

Last Saturday night a breast raffle was held at a dance hall in a western province called La Rioja. The winner turned out to be a 22-year-old man. He decided to give the prize to his girlfriend, and she turned around and negotiated a deal with the dance hall for cash instead. Being a student, she said, she had more need of money than a breast enlargement.

The winning ticket number was 2,757 which shows how many people were interested in the prize. The winner stated that most people were there for that prize. Next time around, there will be two prizes -- a nose job for the runner-up.

Is it ethical?

Some in Argentina are concerned about this method of offering cosmetic surgery and the surgeon who had offered to perform this dance hall's breast augmentation has been criticized. Advertising medical treatments outside of licensed facilities is apparently not strictly legal in Argentina and many feel that a raffle prize is not a good way to put a doctor and patient together.

Breast augmentation is major surgery and does need good candidacy and good planning. There are many choices to be made before you have it done:

• Saline or silicone gel implants?
• Round or teardrop?
• Smooth or textured?
• Under the muscle or over it?
• What size?
• Incision in the armpit, areola or breast crease?

If you are interested in knowing more about how breast augmentation can be done, please call us or send an email. We will be glad to arrange a personal consultation for you.

In Ontario, Canada recently, a family doctor had his medical licence limited because he performed liposuction in his office without adhering to proper professional standards.

• He injected too much saline solution
• He suctioned out too much fat for safety
• He used an excessive amount of anesthetic
• He did liposuction on at least one morbidly obese patient
• He discharged at least one patient only one hour after performing an eight-hour procedure

He must now practice surgery only as a surgeon's assistant in a hospital setting and will also be subject to a physician review and unannounced visits at his private medical offices.

This is a good cautionary tale although Canada has a different surgical environment than the U.S. There are clear limits to how and when liposuction can safely be performed.

1. It is never performed on an obese patient

Liposuction is not a safe or effective way to lose weight. The weight must be lost first and then if there are specific body areas which resist losing weight, the body proportions can be corrected by liposuction on those specific areas. Common areas are the abdomen, hips, upper back and upper arms.

2. The amount of saline solution injected must be carefully calibrated

The saline solution contains lidocaine as an anesthetic and epinephrine to reduce bleeding by constricting blood vessels. These drugs are then metabolized by the body. The liposuction procedure, even done in the safest possible way, still puts stress on the body. If too much lidocaine and epinephrine are injected it will add to the stress.

3. The amount of fat removed at any one time must be carefully limited

Body fluids (blood, lymph, interstitial fluid) are suctioned out with the saline solution and fat. If the patient is not closely monitored and the amounts of fluid in and out are not carefully controlled relative to the patient's weight, the procedure can become life-threatening.

That is because the body's electrolytes (sodium, potassium, calcium, magnesium etc.) must be kept in balance for heart function to be safe. An overly large removal of fat could remove too much of some electrolytes and put them out of balance. (Too much saline solution injected could also create imbalance, since "saline" means "with salt", and salt contains sodium.

Dr. Rai offers liposuction done according to the highest professional and safety standards. You can choose from Traditional, Tumescent, or Ultrasonic liposuction. Dr. Rai has over 20 years of experience in all types of liposuction, is certified by the American Board of Plastic Surgery, and is the Chief of Plastic Surgery at Medical City Dallas Hospital. You could not be in safer hands for your body contouring surgery.

Please contact our office if you would like to know more about liposuction, its safety, and how it could help you.

A study was done by a group called the Freedonia Group in Cleveland Ohio, on cosmetic surgery product use. This group is an international business research company, founded in 1985. According to its own website, it publishes "more than 100 industry research studies annually" which provide "an unbiased outlook and a reliable assessment of an industry (etc)"

This latest study examined the whole $1.9 billion U.S. cosmetic surgery product industry. It made the prediction that use of cosmetic surgery products would increase by 8.4 percent each year for the next four years. It attributed this expected growth to:

• Increasing competition in the workforce
• Aging of the large baby boomer generation
• Greater social acceptance of cosmetic surgery overall
• Botox accelerating the acceptance of injectable fillers

Their prediction specifies that procedures and products which require little or no recovery time will grow the most. It also mentions technology advances being a reassuring factor for those who otherwise might hesitate over having a cosmetic surgery procedure, invasive or non-invasive.

Botox Cosmetic is not an injectable filler, but it may well have stimulated interest in them. Botox works by temporarily paralyzing the specific muscle where it is injected. Most often it is used for frown lines. By blocking the nerve message telling that muscle to contract, it makes the muscle unable to contract, and that smoothes out the frown lines. It is especially effective when done in a series of treatments.

Injectable fillers work by creating bulk in the skin's middle layer, the dermis. Each one uses a slightly different method, but in general they add support to the skin, which creates a smoother and more youthful-looking surface.

Over a period of months up to about 18 months, depending on which filler is used, the body absorbs the injected material and the treatment needs to be repeated. When each treatment is done a little time before complete absorption takes place, the rejuvenated skin appearance can be maintained.

At the Cosmetic Surgical Center, we offer Restylane, Sculptra, Radiesse, and a variety of other dermal fillers. If you would like to know more about them, please contact our office to schedule a personal consultation.