This is a very good question, Judith. I’m glad you asked because it’s one that we hear every week at our practice!

I’ll start with some brief background. The first silicone breast implants were inserted in the mid 1960s. By the mid-1970s, when I began doing surgery, breast implant procedures had become mainstream. During these early years, I don’t recall much discussion with manufacturers, other physicians, or even patients regarding the longevity of such implants. The assumption was that they would last forever and never need to be replaced! But boy, were we all naïve at that time!

Knowing what we know now, hip joints, knee joints, heart valves and pacemakers all wear out and eventually need to be replaced.

The reason that most patients who have received a hip, knee, heart valve or pacemaker don’t require a replacement, is that such implants are frequently placed in older patients who don’t live long enough for the implant to wear out or malfunction. But anyone in their 20s who receives an artificial knee, hip, heart valve or pacemaker surely knows that someday these implants will have to be replaced.

Now we know that all breast implants will rupture eventually if the patient lives long enough. This raises two important questions that need to be addressed:

1) Does a ruptured implant cause a patient any harm?

2) What is the expected duration of a breast implant and when should it be replaced?

Breast Implant Safety Studies

In the early 1990s, breast implants came under scrutiny after numerous reports outlined that older breast implants were frequently found to be ruptured by mammography or during secondary surgical procedures. At the same time, a few reports surfaced questioning whether the presence of silicone led to an increased incidence of autoimmune diseases such as lupus and arthritis.

Gel implants were removed from the market by the FDA until further studies could be conducted. Hundreds of scientific studies were carried out, some retrospective, looking at the history of previously performed cases. Others were prospective, studying patients after new implants were inserted in carefully monitored situations. These prospective studies were set up by the major implant manufacturers in the United States, under the auspices of the FDA, and all data was presented to the FDA. I was chosen to be one of the investigators in these studies and was able to have access to silicone implants during the years that they were not available to non-investigators.

After carefully studying all the data from these studies and other studies worldwide, the FDA concluded that silicone implants do not increase the incidence of any other diseases.

We now know that all breast implants, whether gel or saline filled, will rupture eventually but the important thing to know is that with current implants and early detection, there is little likelihood of harm to the patient following a rupture of either saline or gel-filled implants.

Approval of Silicone Gel Implants

In November of 2006, silicone gel implants were approved by the FDA for breast augmentation in the United States. These are now the most common type of implant used in our practice.

Judith, you mentioned that you were seeing a gynecologist, which is a good thing! Whether or not a person has breast implants, it is highly recommended that each female examine herself monthly for breast lumps and undergo mammography as suggested by your personal physician.

All women, whether or not they are contemplating breast surgery, are encouraged to obtain a baseline mammogram at age 35 (or even sooner if recommended by your gynecologist due to family history of breast cancer) and a yearly mammogram or MRI past the age of 40. In conjunction with your mammogram and gynecological examination, PAP smears should also be performed.

In addition, we strongly believe that any patient who has had any type of implant inserted should see a surgeon of that same specialty as the one who inserted the implant. Do this on an annual basis! For example, if you’ve had a knee implant, please see an orthopedic surgeon every year. Likewise, if a woman has had a breast implant procedure, she should see a plastic surgeon annually.

Why See Your Surgeon Every Year?

Annual visits are recommended for a few reasons. First of all, even though family practitioners or gynecologists may know more than a lay person about knees, heart valves, pacemakers or breast implants, they do not have the in-depth knowledge possessed by a surgeon of inserting specialty. As plastic surgeons, we learn about breast implants every year from our own experience, by attending scientific meetings and from reading plastic surgery journals. Such specialized knowledge is paramount for a thorough, annual breast exam.

Secondly, we occasionally learn in a medical meeting or through an FDA notification of a problem with a product or medication. If we have been seeing a patient who had breast implants inserted many years ago on an annual basis, there is a high likelihood that a letter, email or phone call will get us in touch with the affected patient. On the other hand, if someone has not seen us for many years, there is a high probability that the person has moved, married or divorced and can no longer be reached at the last known address.

Similarly, many patients who had implants inserted many years ago can no longer remember the name of the surgeon who inserted them, which year it was, or what type of implant was used.

At Orange County Plastic Surgery, we see many patients who had implants inserted elsewhere. We are happy to examine any patient on an annual basis as a complimentary service.

How Long Will Breast Implants Last?

This question is a little more difficult to answer. I will start by telling you what happens when an implant gets inserted and why an implant eventually ruptures.

It is normal for a body to make a thin layer of scar tissue around every foreign device that is inserted, be it a chin implant, a knee joint, a breast implant or a pacemaker. If you were to look inside the pocket around a breast implant, you’d see a thin layer of scar tissue, the so-called “capsule.” From the inside, it appears smooth, soft, whitish and looks like the inside of a plastic bag. An implant is basically a loose, floppy bag that has folds in it. Normal movement inside the pocket can cause the shell to fail anywhere along a fold.

After the implants have been in place a long time—say, over 15 years—the body may begin to deposit calcium in this scar tissue around the implant. These calcium deposits grow in size and begin protruding into the pocket housing the implant, just like stalactites and stalagmites grow into an underground cave. Once this occurs, very frequently with implants that have been in place for 20 or more years, the roughened calcium deposits cause the implant shell to rupture.

We strongly recommend replacing all implants that have been in place for 20 years.

A More Natural Look and Feel

Another, purely aesthetic reason that old implants should be replaced is that we rarely see a breast more than 20 years after implantation that still looks great or feels normal. As the pocket contracts and begins to calcify, the breast frequently becomes firm, sometimes uncomfortable, and often looks distorted. This is another reason to replace old breast implants.

While insurance companies, rightfully so, do not cover the cost of implant insertions for cosmetic reasons, most (PPOs, not HMOs) will cover at least a portion of the expenses involved in removing old, contracted, ruptured implants. I have helped countless women with breast revision surgery over the last 30 years and would be happy to see you for a complimentary consultation to answer any of your questions.

One reason breast implant surgery is so popular is because there is a high patient satisfaction from such procedures.

The important thing to take away from this discussion is that implants are safe and rarely lead to problems if inserted properly and replaced before the 20-year mark.

Let me show you an example of an implant I removed this week from a patient who had some firmness, but otherwise felt fine, some 35 years after the implants were inserted.

(Actual patient of Dr. Bunkis) When performing an uplift at the same sitting while replacing an implant (long incisions are necessary for the uplift, which also makes it easier to remove the capsule), it is desirable to remove the old implant in one piece, like a softball, surrounded by an intact layer of scar tissue. This prevents any loose silicone from spilling into the surgical site. Spilled silicone can be removed from a surgical site—just like oil can be removed from a beach or honey can be cleaned from a kitchen floor. But the trick is to not spill it, thereby avoiding the difficult and messy cleanup. After removing the implant and scar tissue in one piece, a new implant can be inserted and the wounds closed before opening the scar pocket to see what’s inside. The patient should have a nice soft breast for the next 20 years.

(Actual patient of Dr. Bunkis) In this case, as we began opening the scar pocket, you can see that the implant had ruptured and free gel was present in the pocket! Good thing we were able to get these out of the body in one piece!

(Actual patient of Dr. Bunkis) Finally, after opening the pocket and removing the broken implant and free gel, I turned the scar pocket inside out, in the same way you would turn a sock inside out to show what was inside the pocket and rubbing against the implant. Note the heavy sheets of jagged, sharp calcium deposits along the upper half of this opened pocket. The bottom contains smooth, soft scar tissue and looks like any healthy lining inside a relatively new capsule. It is these sharp calcium deposits which rupture most old implants.

If you have any specific questions about cosmetic procedures, your best bet would be to see a qualified plastic surgeon to review your options.

Please feel free to contact our office at 949-888-9700 to set up an appointment with Dr. Bunkis. You may also check out our web site at www.orangecountyplasticssurgery.com to see further examples of similar patients.

Thank you for asking, this is an important question. Assuming you are a candidate for both eyelid (blepharoplasty) and neck rejuvenation procedures, you would first need to decide if you would indeed like to have both improved. That can only happen after you’ve had a thorough consultation with a qualified plastic surgeon.

Should you then decide that you’d like both your eyes and neck done, my advice would be to do them together at the same sitting for a couple of reasons:

Recovery Time

The first reason is time spent recovering. If you do just the eyes, you’ll be uncomfortable and bruised for up to two weeks. Likewise, when you have your neck done. If you combine these procedures, the total recovery time will still be about two weeks (instead of losing two weeks twice).

Less Cost, More Uniform Improvement

Aside from time considerations, you will save money by going into a surgery center only once versus twice. Probably the best reason of all to do it in one sitting is that you will be able to enjoy a uniform improvement over your entire face as soon as you have healed. This would be akin to enjoying a house that has been totally cleaned, rather than only half done.

The best way to describe this further is through photographs. Take a look at the accompanying pictures below of a 52-year-old female who chose to have her eyes, face, neck, and brows lifted, and to have a small chin implant inserted—all in a single procedure that took less than four hours!

52-year-old female patient of Dr. Bunkis before and after a brow lift, upper and lower lid blepharoplasty, facelift and chin augmentation.

Side view of the same 52-year-old female patient before and after a brow lift, upper and lower lid blepharoplasty, facelift and chin augmentation.

One of the best ways to envision how you would look following such procedures is through the use of computer imaging.  If you would like to set up a complimentary computer imaging session, please feel free to contact Orange County Plastic Surgery at 949-888-9700.

Q: “I would very much like to enhance my breasts before the bikini season is over! A few doctors I’ve seen have recommended an uplift along with implants, but I was not happy with the pictures of the scars that they showed me. What should I do?” — Sara P., Coto de Caza, CA

A:  Breast enhancement surgery is as elective as it comes and each procedure should be designed to meet the patient’s expectations. The first question you should answer is: what are your expectations?

Many options must be considered when planning breast enhancement. But the planning has to take into consideration each patient’s anatomy and expectations! Breast enhancement can be accomplished via a breast reduction or a breast augmentation (with or without an uplift) or with an isolated uplift. It all depends on the desires of the patient.

An enlarged breast almost always has some drooping of the nipple, and the nipple is raised in most breast reduction procedures. Breast reduction is a separate subject. This article will focus on breast enlargement, with or without an uplift, and isolated breast uplifts without the use of an implant.

Breast Augmentation vs. Uplift

A breast augmentation by itself rarely leaves visible scars. The tiny incisions can be placed in the fold under the breast, around the areolus or in the armpit area.

Breast uplifts, on the other hand, can never be done without leaving a scar that will be visible forever. The surgeon must make sure that the degree of improvement warrants the resultant scaring. If an uplift is attempted for a very minor degree of breast ptosis (drooping), it is unlikely that the patient will be thrilled with the trade off. On the other hand, if the nipples are hanging halfway down to the navel, the minor scaring visible with uplifts will not be much concern to the patient. The trick is to make the right decision for the patient who falls in the grey zone in between these two extremes.

You are correct in thinking that the traditional uplift procedures do leave visible (when naked) inverted “T” scars. But newer techniques today allow a surgeon to obtain similar results with minimal incisions, sometimes limited to a circle around the areolus. Incision patterns chosen by the surgeon will be dictated by the surgeon’s experience, the patient’s anatomy and each patient’s expectations. Basically, the droopier a patient is to begin with, the more skin will be resected and the more scaring can be expected.

When a Breast Uplift Is Recommend

A key anatomical factor in deciding whether or not an uplift is recommended is based on the position of the nipple in relation to the inframammary fold (the fold that runs under the breast). With the patient standing, if the nipple sits above the level of the inframammary fold, a breast uplift is not indicated. If the nipple is an inch or more below the fold, an uplift will be necessary to achieve normal breast shape.

The difficult decisions come when the nipple is within an inch or so of the fold, the so-called grey area. In these situations, the patient (note that I said “patient”, not surgeon) will have to decide if a breast uplift is desirable. In such borderline cases, we help the patient make an informed decision by showing examples of various breast configurations, with or without uplifts, and showing each patient examples of expected scars. Each patient then has to decide whether the improvement in breast shape is desirable enough to warrant the scars associated with a breast uplift.

Breast Lift vs Lift Plus Implant

To help a patient decide between a lift alone versus a lift plus a breast implant, I explain that an implant makes the breast volume increase but does not significantly change breast shape. Conversely, a bra will lift a droopy breast in a manner similar to a breast uplift but, by itself, does not change breast volume. So if a patient is happy with their volume and only wants to be uplifted, an uplift by itself should be recommended. Whereas, if a patient puts on her bra and still feels that a fuller breast would be desirable, she would be better off having an uplift with implants.

Here are a few examples of enhancements to illustrate the difference:

(Actual patient of Dr. Bunkis) A 25-year-old desirous of breast enlargement before and after implant placement. Note that her nipples are well above the fold, so an uplift is not indicted.

(Actual patient of Dr. Bunkis) A 25-year-old mother of two with droopy breasts, nipples just below the level of her inframammary folds, before and after uplift with implant. She was happy with the shape of her breasts in a bra but not with the size. She was a candidate for an uplift with incisions just around each areolus and insertion of implants.

(Actual patient of Dr. Bunkis) A 35-year-old mother of two before and after a breast uplift with a short scar technique. She was happy with her breast shape and size while wearing a bra. Implants were not indicated in this case.

As you can see, the topic of breast enhancement is a complicated one.

Any decision regarding which technique will be most desirable can only be made after a thorough consultation and a discussion of the options and patient expectations.

More information is available at: www.ocps.com

or: www.ocbreastenhancement.com

What’s most important is to find a surgeon who is well-versed in all of these techniques, and to choose the procedure that will give you the results you expect with the least possible amount of scarring.

Please feel free to call Dr. Bunkis at Orange County Plastic Surgery (949) 888-9700 to discuss your options.

— Janet d M., Coto de Caza, CA

A: Mid-facelifts are relatively new, but we have been doing them for 10–15 years. Both types of facelift procedures are designed to turn back the hands of time, but each addresses different aspects of the aging process. A standard facelift is still the ideal procedure to tighten a loose neck and to help with jowls.

You are correct in saying that the mid-facelifts are relatively new procedures, but they address an age-old problem: drooping and hollowing of the cheek areas below the lower eyelids, which creates a so-called “tear trough” deformity. These mid-facelifts can be done as an isolated procedure to freshen a face in the late 30s or 40s that is showing the earliest signs of aging, or combined with a traditional facelift in an older person, or as an isolated procedure in an older patient who has had a traditional facelift but the mid-face was not addressed.

One of the beauties of a mid-facelift is that it can be done through short incisions that are hidden behind the hair line and through a tiny stab wound in the fold between the cheek and the upper lip, just large enough to let us insert a few very long needles, which heals without a visible scar. The mid-facelift will not alter your jowls or neck laxity, so if these are an issue, a traditional face and neck lift will also have to be performed to achieve optimal rejuvenation.

Facial rejuvenation is at the top of the list of the most common aesthetic surgical procedures performed here at Orange County Plastic Surgery. Most people feel physically and mentally vigorous and energetic long after their appearance has begun to deteriorate due to aging. A face, neck, brow or mid-facelift procedure is designed to provide you with a rejuvenated appearance. The degree of improvement achieved depends on the severity of the initial deformity, the age of the patient, tissue elasticity and the recommended procedure.

Here are a few patients that show the benefits of the mid-face and traditional facelifts:

(Actual patient of Dr. Bunkis) 47-year-old female before and after mid-face thread-lift with lower-lid blepharoplasty, without the need for a traditional face or neck lift.

(Actual patient of Dr. Bunkis) Similarly aged, 47-year-old female with neck laxity and jowls, but not much in the way of mid-face laxity, before and after an endoscopic brow lift and facelift. No need for a mid-face here. Conversely, a mid-facelift would not have addressed the things that bothered her most: jowls and neck laxity.

(Actual patient of Dr. Bunkis) 54-year-old female a year after a traditional facelift done elsewhere, neck still quite tight, but complaining of mid-face and lower eyelid laxity. To address her concerns, a mid-face thread lift was performed by Dr. Bunkis to lift the drooping cheek tissues next to the nasolabial fold, thus removing the oblique trough that forms across the cheek as people age, and giving her a nice and youthful cheek. This procedure also elevates the junction between the eyelid and cheek, allowing us to shorten the eyelid, adding to a more youthful look. The “after” photos, six years later at age 62, show that the improvement has been well maintained.

It is important to seek a surgeon who is well-versed in all of the options, so that a customized plan can be developed for your concerns.

Please feel free to call Dr. Bunkis at Orange County Plastic Surgery (949-888-9700) for a complimentary consultation so that we can lay out all your options for you.

Tuesday, April 20th 6:30 PM
Laguna Cliffs Resort and Spa
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Red Hot Speakers on Red Hot Topics:

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From Orange County Plastic Surgery
Anne Floerchinger & Tracy Prescott – Skin Care
Dr. Juris Bunkis – What Plastic Surgery can do for you

See the flyer: Dr. Juris Bunkis – An Evening of Beauty April 20, 2010

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We lived on the hospital grounds and ate local foods, in a relatively Spartan environment. After a breakfast of papaya, beans, eggs and some coffee, we would start seeing patients and deciding who we could help and who we could not – a very difficult experience to say the least! One year, I met a four year old boy who had never walked, with a painful hip and fever. I noticed a mass over the side of his hip and decided to open the area to see what the cause of his problem was – we did not have XRay or laboratory facilities in this town and any specimens had to be sent back to Guatemala City by bus. I was surprised to find a cheesy white material in the joint and did not know what it was – a few days later, we found out that this youngster had TB in his hip joint. There was no way to help him further in Guatemala and I volunteered to take him home with me. He was treated at the Shriner’s Hospital in San Francisco and recovered over a six month period, at which time another team of volunteers brought him back to his village.

We would see patients or operate from about 7 am until 7 pm each day for about ten days straight, and during this time, performed about 150 operations. The bulk of the patients I was were kids with a variety of birth defects or injuries. But in the early 80’s, while civil war raged in Guatemala, it was not unusual to see someone in fatigues come in for treatment of an injury, and we never asked which side they were on! We were there for the kids and neither side saw any advantage in harassing us! As a matter of fact, the government was quite helpful, expediting our trips through customs, providing us with the yellow school bus to bring us to Neuvo Progreso, and giving us armed guards for the journey.
Whenever we could, we did an adult patient as the first one for each trip – adults are more forgiving and we did not want to “test the system” on a malnourished 3 month old! A different group of volunteers went down to this village four times a year but in between, the hospital was run by the real heroes in this story, the nuns from Mexico and Spain, and the padre from Italy, who live there permanently and have given their lives for the local people!

At the end of the ten days of working there, we head back to Guatemala City and fly home, fatigued, usually a few pounds lighter and as content as a person could possibly be! There is nothing more fulfilling than helping those in need!
And before I sign off, I’d also like to mention our registered nurse, Tracey Prescott and some of her escapades abroad to help others. Here in Orange County, Tracey helps patients with pre and post op care, injects fillers and Botox, does laser hair removal and skin resurfacing. But when time allows, she’s off helping other!
Happy Thanksgiving from all of us at Orange County Plastic Surgery!

• The Lip Plumper improves lip volume and fullness while smoothes the appearance of fine lines. The product gently conditions lips, making them smooth and soft. It contains four categories of ingredients:

Plumping Agent:

• Palmitoyl Oligopeptide (Maxi-Lip ™)
• Centella Asiatica Extract (Gotu Kola)

Antioxidant:

• Tocopherol and Camellia Oleifera (Japanese Green Tea) Leaf Extract

Lip Conditioners:

• Beeswax, Allantoin, Dimethicone, Aloe Barbadensis Leaf Extract and Anthemis Nobilis (Chamomile) Flower Extract

Moisturizer (Emollients/Humectants):

• Sorbitan Isostearate, Ethylhexyl Palmitate, Glycerin and Sodium PCA

How does this product work? The mechanism of action includes stimulation of collagen synthesis, stimulation of glycosaminoglycans and maintenance of the newly formed Collagen. This will result in a 30% reduction of furrows (note, not 100% but hey, 30 % isn’t that shabby considering that no surgery or injections are required!). Lip moisture will be increased by as much as 60%! And finally, lip volume will increased by an average of 40%! I think you can see this new product has been so desirable!

The Vivité Daily Firming lotion tones and tightens dimpled “orange peel” skin as no other non surgical procedure before it! It improves skin elasticity and firmness for a smooth, sleek look. It uses an advanced formula which hydrates and moisturizes the skin to keep it soft and smooth. This product likewise contains four classes of ingredients:

Slimming Agents:

• Caffeine
• Isomerized Linoleic Acid (Regu-Shape)

Antioxidant:

• Olea Europaea (Olive) Leaf Extract

Skin Texturizers:

• Glycolic Acid & Ammonium Glycolate (pH 3.8)

Moisturizer (Emollients/Humectants):

• Cyclopentasiloxane/Cyclohexasiloxane, Isohexadecane, Dimethicone, Ceresin, Glycerin, Sericin, and Lecithin

This product works by reducing lipid uptake and accumulation into the adipose tissue, by accelerating the cAMP pathway, and by reducing fluid level between cells. This results in a reduction in the size of the lipid droplets, a reduction in the lipid content of the adipose tissue, a reduction of thigh circumference and a smoother appearance of the skin. In an initial study, six women between the ages of 40 and 61 with mild to moderate cellulite or “orange peel” skin on the thigh applied Vivité Daily Firming Lotion twice a day for 8 weeks. Expert Grader evaluations were made at baseline, 4 and 8 weeks post treatment. Amazingly, five of the six subjects demonstrated a reduction in thigh circumference. The average change over the 8 week period was 0.65 inches. Additionally, favorable changes were observed in the appearance of cellulite, skin dimpling and skin elasticity/tightness with no adverse events being observed during the course of testing. In conclusion, Vivité Daily Firming Lotion is effective at reducing thigh circumference by more than half an inch on average as well as improving the overall appearance and condition of the skin.

If you have any specific questions about these products or any cosmetic procedures, your best bet would be to see a qualified plastic surgeon to review your options. Pease feel free to contact our office at 949-888-9700 to set up an appointment with Dr. Bunkis; you may also check out our web site at www.ocps.com to learn more about our practice.

I am interested in having a facelift but as you know, we are blessed in California in that there is on shortage of plastic surgeons to choose from. I suspect that one of the more important things for a consumer to look at is a surgeon’s background. Could you please tell us something about your background – and any other tips you could give someone looking for a surgeon.
Michael M Dove Canyon, CA

Well, Michael, you are right – in most beautiful, relatively affluent areas, there isn’t a shortage of plastic surgeons, lawyers, contractors, CPA’s and so forth. I think there are three things that separate surgeons that you should consider.

• training and background
• surgical skills
• bedside manner

There is no substitute for a good education, and I would be hesitant to choose a surgeon who has not been well trained, who is not Board Certified by the American Board of Plastic Surgery, and who does not keep up with his or her continuing medical education (this is a life-long process). But even amongst equally trained physicians, you will find wide variation in surgical skills. Ask to see multiple examples of a surgeons work. And finally, all else being equal, there is no point going to a surgeon you do not connect with on a personal level.

I will begin by going over my background. I have made a name for myself as an innovative plastic surgeon who specializes in aesthetic surgery, with a successful practice that has thrived for 30 years. As medical director of Orange County Plastic Surgery (OCPS), I have a 5-Star practice here in South Orange County but also continue to see patients in northern California, where I got my start in plastic surgery. I stay busy through referrals from satisfied patients from around the globe, who frequently cite my caring, attentive approach and expert surgical skills. When you come in to see us, we will make sure that you see many examples of my work – after all, I have done facelifts on five of my employees over the years and what better way to show you what we are capable of?

My philosophy is based upon the concept that a successful result from cosmetic surgery stems from a successful partnership between the patient and the surgeon. Such a partnership is based on professionalism, trust, education, and understanding. I make it a priority to really listen to the patient’s concerns — our goal is to help our patients achieve their aesthetic surgery goals and as a result, feel better about themselves.

I have an impressive academic background, having served as Assistant Clinical Professor of Surgery, Division of Plastic Surgery at the University of California at San Francisco School of Medicine. Upon graduating from the University of Toronto Medical School in 1974, I completed a general surgery residency at the Mary Imogene Bassett Hospital, Columbia University in New York and the Beth Israel Hospital, Harvard University in Boston. This was followed by board certification in general surgery. I subsequently returned to Harvard University to complete my residency in plastic and reconstructive surgery – my professor, Dr. Joseph E. Murray, a very impressive man, was a Nobel Prize Laureate in Medicine. In 1981, I joined the plastic surgery faculty at the University of California at San Francisco School of Medicine and was subsequently appointed Chief of Plastic Surgery at the San Francisco General Hospital. I am a diplomat of the American Board of Plastic Surgery and a fellow of the American College of Surgeons. Dr. Bunkis is a member of the prestigious American Society for Aesthetic Plastic Surgery and the International Society of Aesthetic Plastic Surgery. Surgeons from around the world are frequently seen visiting us at Orange County Plastic Surgery.

Next I will tell you a little about the practice itself. OCPS is a state-of-the-art plastic surgery center offering a comfortable environment and the very latest advances in cosmetic surgery. OCPS specializes in the newest techniques for face and forehead lifts, including the mid-face and short scar face lifts, blepharoplasty (eyelid surgery), rhinoplasty (nasal surgery), liposuction, abdominoplasty (tummy tuck), post weight loss body sculpting (body lifts), breast reduction / uplift through the short scar techniques, and augmentation mammoplasty (breast enlargement). Other treatments include Botox ® and the latest filler injections, laser skin resurfacing and laser hair removal. I also am one of only a handful of plastic surgeons to perform pectoral, buttocks and calf implant surgery.

If your goal is to look younger, OCPS can help. Bringing together the very special talents and surgical expertise of its professional staff, OCPS offers an array of exclusive anti-aging treatments to help you recapture that youthful glow. Services include facial rejuvenation utilizing the latest lasers, mid-face and endoscopic brow lifting techniques, as well as eye lid and nasal surgery. Best of all, the center’s computer imaging system will give you a sneak preview of the expected outcome so you can make an informed decision about your surgical procedure. OCPS has a state-of-the-art laser suite featuring a variety of lasers especially adapted to treat fine lines and wrinkles, spider veins, Rosacea and other pigmented lesions of the face and body.

In addition, Orange County Plastic Surgery offers a full line of skin care including custom-designed skin care, Vi-Peels ®, European facials and specialized skin care treatments.

Are you ready to make some positive improvements to your appearance? Dr. Bunkis and his expert staff can sit down and review your goals and options, and ensure that your aesthetic surgery dreams become a reality.

Distinctions and qualifications:

• 30 years experience
• California’s premiere facial and body rejuvenation centers
• Minimally-invasive and “quick-fix” anti-aging treatments
• Complete aesthetician services
• Convenient south Orange County and San Francisco East Bay locations

If you have any specific questions about cosmetic procedures, your best bet would be to see a qualified plastic surgeon to review your options. Pease feel free to contact our office at 949-888-9700 to set up an appointment with Dr. Bunkis; you may also check out our web site at www.ocps.com to see further examples of similar patients.

Actual patient of Dr. Bunkis: 67 year old male with lax neck, who wished to have it improved to increase his value in the workforce, before and two years after a neck lift and a lower lid blepharoplasty.

We would not be able to tell you which option would suit you best without examining you in person. Having excess skin and fat following multiple pregnancies or non-pregnancy associated weight loss is a common complaint. Abdominal bulging may be due to residual weakness of the underlying muscles following stretching from excess internal fat or a baby. In addition, not all stretched skin returns to its normal tension, and unwanted fatty deposits may accumulate or persist following pregnancy or weight loss. Abdominoplasty (tummy tuck) deals mainly with the excess skin and fat in the front of the belly, and is the appropriate procedure in the vast majority of patients who present following pregnancy and without a history of massive weight loss. A tummy tuck consists of undermining the abdominal wall skin and fat, tightening the muscles, cutting away the extra, lower, anterior abdominal tissues and redraping the remaining skin. Liposuction may be used as an adjunctive tool to help sculpt the fat deposits in the flank or thigh areas. The lower body lift procedure deals with circumferential excess of fat and skin e.g. belly, thigh, and buttock. The posterior trunk, buttocks and thigh skin does not get stretched in an average pregnancy, and this procedure is usually performed on patients who may have lost in excess of a hundred pounds with a diet and exercise program, or following gastric bypass or stapling procedures. It is a more extensive procedure but yields good results in patients with excess skin and fat in these areas.
If you have any specific questions about cosmetic procedures, your best bet would be to see a qualified plastic surgeon to review your options. Pease feel free to contact our office at 949-888-9700 to set up an appointment with Dr. Bunkis; you may also check out our web site at www.ocps.com to see further examples of similar patients.

Actual patient of Dr. Bunkis: Pre & Post Abdominoplasty: 40 year old African American with a prior vertical lower abdominal GYN scar, before and after abdominoplasty with liposuction of the flank areas.

Actual patient of Dr. Bunkis: Pre & Post Lower Body Lift: 29 year old following significant weight loss, before and after belt lipectomy to address the circumfential tissue laxity.

SILICONE GEL BREAST IMPLANTS
PANACEA OR TIME BOMBS?

By Juris Bunkis, M.D., F.A.C.S., Medical Director, Orange County Plastic Surgery Rancho Santa Margarita, CA

Fashion may be fickle but women have been coveting bigger breasts for centuries. More and more women opt for breast augmentation each year. 212,500 breast augmentations were performed in the year 2000 but the number had increased to 291,350 by 2005, a 37% increase, and in spite or our current weak economy, this number just continues to grow! In November of 2006, silicone gel implants were reapproved by the FDA for breast augmentation in the United States and this created a flurry of interest in breast augmentation with gel implants. In review, the first surgical attempts at breast enlargement occurred in the 1890’s using paraffin injections but the long term results were less than satisfactory. By the 1920’s, this technique has been replaced by fat transplants. Surgeons would remove large blocks of fat from the abdominal wall or buttocks and place it into the breasts. The results were satisfactory initially, but shortly thereafter, the fat would begin to absorb, abscesses would form and the patient would be left with a lumpy breast, not much better than the ones enlarged with the paraffin. In the 1950’s, polyvinyl sponges were developed and utilized for breast augmentation. Upon implantation, these would inevitably turn into hard balls within the breasts. In the 1960’s, prostitutes in Japan and the United States began receiving liquid silicone injections to increase bust size, but long term, results were similar to paraffin with lumpy, painful breasts with frequent abscess formation. During my years teaching at the University of California in San Francisco, I had occasion to treat a number of poor ladies with hard, lumpy, infected breasts many years following free silicone injections – the only effective treatment was a double mastectomy and subsequent breast reconstructions. None of these historical procedures produced very satisfactory results and breast enhancement remained an uncommon procedure, rarely performed by reputable physicians. But all this changed with the introduction of silicone gel implants in 1963. These implants consisted of a silicone rubber bag filled with a silicone gel. The consistency was that of normal breast tissue and complications were far fewer than with prior surgical attempts at breast enlargement. By the early 1980’s, breast augmentation was accepted as a main stream procedure and had become one of the most frequently performed aesthetic surgical procedures. In the 1970’s, physicians attempted using saline implants, silicone rubber bags which has been filled with salt water, in an effort to decrease the incidence of capsular contractures, a thickening of the scar around may of the breasts first implanted with gel implants. The popularity of the saline filled implants remained low because these implants did not feel as natural as gel filled implants, and the early saline implants had a very high rupture rate.

Most patients implanted with silicone gel devices during the 60’s and 70’s experienced some hardening of the breasts and other complications but patient satisfaction with the procedure remained high because these implants were far superior to the sponges and other materials used prior to the introduction of the gels. Refinements in implant materials and surgical techniques lead to improving results throughout the 1980’s, and continued popularity of such implants. By the early 1990’s, more than two million women world wide had such implants in place. A Connie Chung television show in 1991 raised doubt regarding safety of breast implants, bringing to light that many patients were now walking around with ruptured breast implants and questioning whether breast implant patients had a higher likelihood of developing autoimmune diseases such as arthritis or lupus. Much publicity ensued and the safety of implants was reviewed by the FDA as well as other regulatory health agencies world wide. Most issued rulings that the safety of silicone breast implants had to be studied further and such implants were removed from the market. And studied they were! Literally hundred of scientific studies were carried out, some retrospective, looking at the history of previously performed cases. Others were prospective, studying patients after new implants were inserted in carefully monitored situations. These prospective studies were set up by the major implant manufacturers in the United States, under the auspices of the FDA, and all data was presented to the FDA. I was chosen to be one of the investigators in these studies and was able to have access to silicone implants during the years that they were not available to non-investigators. After carefully studying all the data from these studies and other studies worldwide, the FDA concluded that silicone implants do not increase the incidence of any other diseases. We now know that all implants, whether gel or saline filled, will rupture eventually but the important thing to know is that with current implants and early detection, there is little likelihood of harm to the patient following a rupture of either saline or gel filled implants.

What has changed to make today’s breast augmentation results superior to those of the 1960’s or 1970’s? The gel that was used in the 1960’s through the 1980’s was a thick, gooey liquid. The gel in implants today is “cohesive”, the consistency of a Gummy Bear – when cut in half, these implants stay in one piece and do not “leak”. Secondly, in a mistaken effort to make the implanted breasts feel softer, manufacturers of silicone gel implants up to the 1980’s utilized paper thin shells. Implanted breasts still formed scar tissue and became firm on occasion, but the shells leaked and ruptured frequently. Today’s implants contain thicker and more durable shells. And finally, surgical techniques have improved greatly since the early days of breast implantation. Incisions now much shorter and more hidden, a variety of different approaches, including entry through the arm pit or nipple area, have been developed and placement of the implants beneath the pectoralis major muscle has been perfected.

One drawback of the gels is that ruptures are difficult to detect. With a saline implant, the water gets absorbed by the scar tissue surrounding the implants and the problem is immediately evident as the breast deflates. With ruptured gel implants, the breasts will look and feel the same and the only way to confirm that a rupture has taken place is with annual mammograms or an MRI. We now know that the presence of a ruptured implant cannot cause any diseases, but why would someone elect a gel if a rupture is more difficult to detect? The answer is quite simple – gel implants are far superior to saline filled bags in feel. Patients with saline implants have a higher likelihood of a firm or unnatural feeling breast. Also, surface ripples and wrinkling, or a palpable implant, are far more likely with saline implants. Many patients who were implanted with saline implants during the last 15 years are now coming in to have their breasts evaluated with the thought of replacing their implants with the new gels. But are gel implant for everyone? Dr. Dennis C. Hammond of Grand Rapids, MI, a recognized expert in the plastic surgery community, recently stated, “There is a whole generation of surgeons out there who trained after silicone implants were removed from the market in 1992 and they have had a satisfactory experience with saline implants. Many of these surgeons will continue to use saline implants”. In my opinion, the proper thing to do at this time is to provide each patient with the pros and cons of all available implants types and to let them participate in the implant choice. But once my patients have had a full consultation, including an opportunity to see or feel both types of implants, most today choose a gel implant for themselves.

If you have any specific questions about cosmetic procedures, your best bet would be to see a qualified plastic surgeon to review your options. Pease feel free to contact our office at 949-888-9700 to set up an appointment with Dr. Bunkis; you may also check out our web site at www.ocps.com to see further examples of similar patients.

Actual patient of Dr. Bunkis 18 year old female, before and after axillary approach, subpectoral breast augmentation.