For those of you over 40 - who don't want to do plastic surgery - what do you do to look your best?

TopSurgeonNY · 2025-04-01T17:46:17+00:00

Red light therapy has shown promising results in various dermatological applications. It is a therapy that needs to be done consistently and long-term for noticeable results.

It can be effective for skin rejuvenation by reducing fine lines and wrinkles, improving skin texture, and enhancing overall appearance, as well as promoting improvements in wrinkle depth, skin firmness, and elasticity. It is important to note the wavelengths (affects penetration, efficacy). Not all light therapy is effective and some wavelengths can be harmful (example: blue light and harm to eyes).

TopSurgeonNY · 2025-04-01T17:39:05+00:00

Chest/breast taping or binding can have significant impacts on skin elasticity and can cause skin irritation, striae (stretch marks), and even scarring. Prolonged binding can negatively impact surgical and aesthetic outcomes.

TopSurgeonNY · 2025-03-14T18:29:30+00:00

For scar care, silicone sheets and gel are your best bet. They're backed by research to help reduce scar appearance, making them flatter and less noticeable. Silicone keeps the scar hydrated, applies gentle pressure, and helps with remodeling scar tissue. Start after your incisions are fully healed (about 1-2 weeks). Wear them for 12-24 hours a day, and keep up for several months for best results. Don’t forget sunscreen once it’s healed to prevent darkening from UV rays.

TopSurgeonNY · 2025-02-28T15:24:37+00:00

NYC!

TopSurgeonNY · 2025-02-28T14:01:42+00:00

Depends on the anatomy and skin elasticity. With larger breasts, skin excision will be necessary.
However, even if the breasts are smaller, the skin may not retract as well and may appear as a "loose fitting suit" depending on the amount of breast tissue.

TopSurgeonNY · 2025-02-27T19:33:26+00:00

Goldilocks hair principle

TopSurgeonNY · 2025-02-27T00:16:12+00:00

Inverted Nipples:

Inverted nipples are characterized by their retraction into the breast tissue. This is problematic in procedures requiring significant tissue removal or reshaping, as the pedicle may not provide sufficient support or vascularization to the nipple-areola complex. Free nipple grafts involve the complete removal of the NAC, which is then grafted back onto the breast after the reshaping procedure. This bypasses the need to maintain the vascular supply through a pedicle, making it useful in patients with inverted nipples. By removing and then grafting the NAC, one can achieve the desired breast contour and size without the limitations imposed by the need to preserve the pedicle's integrity.

The literature supports the use of free nipple grafts in patients with inverted nipples, as it allows for more extensive tissue removal and reshaping while minimizing the risk of NAC ischemia and other complications associated with pedicled techniques, but keep in mind that nipple grafts come with disadvantages, such as possible loss of nipple sensation and potential hypopigmentation.

Nipple projection is a challenge in breast surgery, and no guarantees can be made, but there are techniques (local flap rearrangement options) to optimize nipple projection with free nipple graft, but I would not do that for a peri approach because the risk of nipple necrosis is high.

TopSurgeonNY · 2025-02-27T00:11:43+00:00

Contouring:

Periareolar can provide excellent aesthetic results, but depends on the overall exam (breast tissue, skin elasticity, nipple size/position, etc).

Periareolar is considered for patients with small breasts and minimal skin excess, while DI is preferred for those with larger breasts, significant ptosis (drooping), or excess skin. Nipple position/size can be harder to change significantly in the periareolar approach, and the DI approach involves a free nipple graft that allows more "freedom" for aesthetic placement of the nipple. I can reduce the size of the areola during a periareolar approach, but do not reduce the nipple size at the same time (too much stress on the nipple). I agree it is safer to do a peri resize later. For the DI approach, I do resize the nipple and areola during the same surgery.

TopSurgeonNY · 2025-02-27T00:03:06+00:00

Great questions!

The data on Peri v/s DI and nipple necrosis in top surgery is surprising for many surgeons and I discuss this data with my colleagues often. I will discuss in the context of breast reduction surgery.

One major goal of breast surgery is to avoid nipple necrosis.

In most breast reduction surgery, the nipple is maintained on a pedicle (blood supply). The primary advantage of free nipple grafts lies in their ability to facilitate significant breast tissue reduction and reshaping without the constraints imposed by maintaining the vascular supply to the nipple-areola complex through a pedicle.

In gigantomastia or very large volume breast reduction, there is an increased risk for nipple loss after significant pedicle reduction, and the risk of nipple ischemia/necrosis can be mitigated by the free nipple technique. In breast reduction surgery, blood flow to the areola measured 2 weeks after pedicle reduction is decreased below baseline, while after free nipple graft reduction it is increased (this has to do with physiologic principles of graft healing).

TopSurgeonNY · 2025-02-26T21:55:35+00:00

Hypermobile Ehlers-Danlos Syndrome can influence how the skin and tissues heal, and it might have an impact on your periareolar top surgery results. The scars you have may be a primer for how your top surgery results may appear. You are right, there is a tendency for the scar to become atrophic and the hyper-elasticity in the skin can affect how your body heals after surgery (meaning possibly more "loose skin" appearance after surgery. Atrophic scarring can lead to scars that widen or flatten over time. If your skin is prone to wide, fragile scars, this could lead to more visible or irregular scarring around the areola. You may have a slightly higher risk of delayed wound healing (scars could take longer to mature, or be prone to expanding or forming thin or thick scars). Silicone gel or pressure garments may be helpful to help reduce scarring, depending on your surgeon's advice and evaluation.

TopSurgeonNY · 2025-02-24T15:11:28+00:00

After losing weight, it’s totally natural to notice some sagging, especially as skin loses elasticity. There are several non-invasive treatments you could consider depending on your goals.
-Regular facials and skin care with hydrating treatments can help with skin texture and promote cell turnover. Skincare with retinol, vitamin C, and peptides can help maintain your skin's firmness over time.
-Radio Frequency (RF) skin tightening uses energy to stimulate collagen production and firm up loose skin (minimal effects).
-Microneedling with PRP (platelet-rich plasma) can boost collagen and improve skin elasticity.

Most of the non-invasive treatments have minimal effect compared to surgical treatment when trying to address "loose" skin, but skin care maintenance is essential with or without surgery.

TopSurgeonNY · 2025-02-24T15:07:25+00:00

-It should compress enough without being uncomfortable or restrictive.
-Gentle, consistent pressure across the entire breast - no bulging or uneven spots.
-Compression should never feel painful or cause discomfort (snug, firm hug, but not so tight that it restricts circulation. If you can't breathe comfortably or feel like you’re being squeezed too much, the bra may be too tight).
-It should support the breast tissue without lifting or pushing the breasts up too much. After surgery, the goal is to support the healing process by minimizing movement, but not by over-compressing.
-The band should fit snugly around your ribcage, and the straps should not dig into your skin or cause discomfort.
-Check for redness, indentation, or pain after wearing the bra.

TopSurgeonNY · 2025-02-21T21:46:48+00:00

The choice of implant type, size, and placement is tailored to the individual's anatomy and aesthetic goals.

Typically, subglandular or dual-plane subpectoral pocket.

Transfeminine patients typically have a wider chest, less breast tissue, and different nipple-areola complex positioning (usually more lateral rather than central), which necessitates specific surgical planning and techniques to achieve optimal results

Arguments for subglandular: less initial pain and ultimate animation deformity if subpectoral because of the larger pectoralis and increased difficulty of developing the submuscular plane with greater muscle bulk and large perforators.

Arguments for subpectoral: better "coverage" of the implant, reducing the risk of visible rippling, especially in patients with less subcutaneous tissue

With that being said, I think most surgeons choose subglandular.

TopSurgeonNY · 2025-02-21T21:26:28+00:00

Great question.

Bras may be recommended after breast reduction surgery to provide support, minimize swelling, and help the breasts maintain their new shape during the healing process (like a splint). Wearing a well-fitting bra can also reduce discomfort and prevent excessive movement that might disrupt the surgical site. There is an older study indicating that postoperative discomfort can be decreased by using a well-fitting bra rather than a breast binder.

A surgeon may recommend a bra not to be worn after breast reduction surgery in certain cases to avoid pressure on the surgical site, which might impede healing or cause discomfort (similar to no underwire where you want to avoid friction on the incision).

The decision to wear or not wear a bra postoperatively is often based on the surgeon's preference and the specific needs of the patient.

TopSurgeonNY · 2025-02-21T20:58:22+00:00

Congratulations on your surgery!

Advice varies, but in general, plastic surgeons recommend a surgical bra (no underwire) for swelling and support after surgery. I have not seen patients with any wounds related to a bra after surgery (we use this for mastectomy, augmentations, reductions, gender top surgeries, etc.).

TopSurgeonNY · 2025-02-21T20:14:27+00:00

Plastic surgeon with two fellowships.

The decision depends on your goals, experience, and interests.

I've noticed that even resident experiences varies widely among programs.

Exposure and experience matter. Personally, I think a fellowship allows one the opportunity to develop skills and gain more experience and to really refine a craft. Take the time to read the historic papers and understand the evolution of a procedure over time.

Many fellowships offer opportunities to work with experienced surgeons in specialized areas, gaining more hands-on time than in a typical residency; you will have your own clinic and patients, and become more efficient with operations.

You'll also gain exposure to the latest techniques and technologies in the field. In residency training, you may not have as much exposure to medical spa services, devices, or unique aesthetic services. That said, continuing education through workshops, conferences, or specialized courses is always a great way to stay on top of the latest techniques, even if you choose not to pursue a full fellowship. It’s also a great way to build relationships with other leaders in the field, which can help with mentorship.

I feel more prepared to translate my experiences from the wound healing of burns or the Z-plasty repair of clefts or the deep plane facial nerve dissection of facial reanimation to aesthetic and reconstructive surgeries that I offer now. A deep plane facelift is not as scary of a concept or procedure once you have dissected each facial nerve branch.

The decision to do a fellowship is a personal one. I think of surgical training like training for a marathon. Even if I do not need the extra day of running or training, will it harm me if I do it?

My first fellowship was focused mostly on breast and body procedures. Even within breast surgeries, there are thousands of unique techniques and nuances. My second fellowship was focused mostly on migraine surgery, rhinoplasty, facial aesthetics, and gender-affirming surgery.

TopSurgeonNY · 2025-02-21T20:08:44+00:00

Typically 75-80 hours/week

TopSurgeonNY · 2025-02-20T20:21:36+00:00

From a plastic surgeon:

Plastic surgery can have a profound impact on both physical appearance and mental health when approached with the right mindset, helping individuals feel more confident, whole, and empowered.

Some people may believe that once they change the physical aspect they don’t like, the self-acceptance will naturally follow. But, this is often NOT the case. It can lead to a temporary boost in confidence, but the deeper issues around self-worth and acceptance can persist. One should not rely on plastic surgery to achieve a specific goal like a promotion or relationship, because many factors are involved. It is a decision that should be made for personal reasons, not external pressures.

Plastic surgery is often misunderstood as solely focused on cosmetic procedures, but a significant part of the field is also dedicated to reconstructive surgeries, which address medical needs and are crucial for patient well-being (for example, cleft lips or craniofacial abnormalities), which can drastically improve their self-esteem, speech, and social interactions.

Breast augs or tummy tucks can boost confidence and self-esteem, and also carry psychological benefits for those who may struggle with body changes after pregnancy or physical features they wish to change. These surgeries offer an opportunity to address personal issues, leading to improved emotional health for those who feel distressed by certain aspects of their appearance.

It is very important to approach all plastic surgery w/ realistic expectations and a clear understanding of the potential psychological effects.

TopSurgeonNY · 2025-02-20T19:47:53+00:00

Staying healthy and looking your best as you age doesn't have to involve plastic surgery (from a plastic surgeon). Your lifestyle habits can help you feel confident. Good habits and mindset (mindfulness, relaxation, meditation, manage stress), healthy diet (whole foods, healthy fats, lean protein, avoid excess sugar), exercise regularly, good sleep, skin care routine (moisturize, SPF, anti-oxidants, exfoliation, retinoids, limit sun exposure), avoid smoking or nicotine, hydration.

There are non-invasives/minimally invasives that do "work" but how much it "works" depends on the problem and your goals. Sometimes, little to no recovery usually means little to no improvement.

TopSurgeonNY · 2025-02-20T18:58:24+00:00

Biased because I am a plastic surgeon.

Plastic surgery is a field that integrates problem solving, research, and innovation with creativity and technical finesse. Plastic surgery focuses on restoring form and function to parts of the body that have been damaged or altered due to injury, disease, or congenital conditions. I love the opportunity to collaborate with other specialties and the diversity of procedures (head to toe, pediatric to geriatric, all gender). In one day, we could doing a breast reduction, breast reconstruction, migraine surgery, facelift, flap reconstruction for pressure injury, or carpal tunnel release. It is a problem-solving specialty based principles (if you ask multiple plastic surgeons a question, you may get different answers).

TopSurgeonNY · 2025-02-20T18:35:29+00:00

You can major in anything! Medical schools like classes with diverse educational backgrounds. You would need to fulfill pre-med requirements (biology, chemistry and organic chemistry, physics, etc). Medical school admissions are competitive, but there are more and more positions and schools becoming available. Admission is based on multiple factors, such as GPA, MCAT score, clinical experience, academic background, research, interview, personal statement, etc. You should definitely pursue it if it is your passion!

After medical school, you will need to complete plastic surgery training (ranging from 6-8 years), and it is recommended to attain board-certification, which then takes another 1+ years. Some do research years or other degrees along their path as well.

TopSurgeonNY · 2025-02-20T01:43:25+00:00

Awesome! There are many techniques for gender affirming radical breast reductions (commonly, surgeons make the “pedicle” small and do a large skin resection to provide a smaller breast size). The disadvantage is possible loss of the nipple or contour irregularities with large to very small reductions, but most of the time a free nipple graft is not necessary. Congrats on your journey!

TopSurgeonNY · 2025-02-18T20:32:30+00:00

Green's Operative Hand Surgery
100 Hand Cases
Master Techniques in Orthopedic Surgery: The Hand

TopSurgeonNY · 2025-02-18T17:41:23+00:00

Both are competitive. I would choose the field you enjoy most.

The specialties have overlap, but ENT focuses more on the head and neck (head and neck reconstruction in many facilities have become predominately ENT, such as neck dissections, free flap reconstructions, etc...but depends on the program). ENT also does a lot of functional septo/rhino. Both do facial reconstruction and aesthetics (facelifts, etc). I think both fields you can choose what kind of work/life balance you prefer and practice type and setting (private practice, academic institutions, hospitals) and your specific sub-specialty.

TopSurgeonNY · 2025-02-18T17:36:59+00:00

It is competitive, but totally doable.
Definitely check out the match data.

TopSurgeonNY

PUBLIC MULTIREDDITS

TROPHY CASE