April, 2016 - Issue #138
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When having breast augmentation, how do I know what size and implant type will be best for me?
The public image of the ideal implant size has changed over the years. Many years ago, breast augmentation was all about bigger is better, whereas today's patients generally prefer results that simply look natural. It is important for each patient to talk to their doctor about whether their body size or their amount of tissue can support implants of a certain size while still looking natural and complementary to one's body type. Also important is placement; patients should select a doctor that has extensive experience and a track record of terrific results. In most cases, the best results come from implants placed below the muscle tissue in order to achieve a more natural slope of the breast. In addition to desired size, the main decision to make involves what type of implant will be best for a patient. There are three FDA-approved implant types: silicone, liquid-filled saline, and firm-but-pliable cohesive gel implants. Each type of implant has its benefits. A highly experienced plastic surgeon will be able help you decide which implant is best for you and your situation. Silicone tends to be the preferred filler for a majority of patients as it has the same consistency and texture as human fat, making it a suitable choice for patients seeking a more-natural result. We offer free consultations so that we can answer all your questions and help you get the results you desire.
Dr. Andrew T. Cohen, MD, FACS, board-certified plastic surgeon of Beverly Hills Physicians 249-4040

What is osteoarthritis of the hip and knee joint?
Well, in a phrase: "Not the best of news." This degenerative joint disease occurs when your joint's surface cartilage wears away, leaving the raw bone beneath it exposed. With the "pad" gone, the now-roughed joint surface causes stiffness and pain. Often, this discomfort can be managed with rest, modifications in activity, anti-inflammatory meds, joint injections or ice. But as the damage progresses, the pain often becomes less responsive to these interventions and surgery gets put on the table. Total joint replacement surgery - including anterior hip replacement surgery - are options that can help you get back to life again. These procedures can be performed with minimally-invasive techniques by a select group of practiced surgeons.
Dr. Alon Antebi and Dr. Justin Sherfey of AVORS 705-5100

How long does laser vision correction surgery last?
Many people believe that laser vision correction only lasts a certain amount of time. On the contrary, studies have proven that laser vision itself produces very stable results over a person's lifetime. However, the eyes themselves go through different stages in life which can lead you to think that the effect of laser vision correction has worn off. The first change that occurs usually happens when a person goes through their 40s. This change has recently been termed "dysfunctional lens syndrome." During your 40s, the crystalline lens inside the eye begins to lose its flexibility. When this happens, unless someone is near-sighted, a person loses their ability to read comfortably or even at all without glasses. If someone was corrected for distance vision in their 20s or 30s, this change would make them believe the results of their surgery were wearing off. The next big change in vision occurs when one develops cataracts. Cataracts develop as the crystalline lens inside the eye begins to lose clarity. Neither of these phases are caused by laser vision correction but are natural age-related changes that can be treated in a variety of ways.
Dr. Craig Helm of Helm Vision Group 259-3937

Are bleeding gums normal?
It's not normal for your gums to bleed. The typical cause is periodontal disease. Periodontal disease is an infection of the gums and bone that support teeth. It usually starts early in life and progresses as a person ages. It begins when plaque hardens into tartar (also called calculus) below the gum line. This irritates soft tissues and infection can set in.

As the condition progresses, gums recede from teeth and pockets of bacteria form. The bacteria can destroy gum tissue and bone, causing tooth and bone loss. Most patients don't recognize the symptoms of periodontal disease which include red, tender, swollen gums, bad breath, bleeding when brushing teeth and discomfort while eating. Routine visits to a dental professional along with brushing and flossing will make your gums look and feel great!
Dr. Patricia Guerrero, DDS Everbright Family Dentistry 296-3300

What is "minimally-invasive" spine surgery?
Minimally-invasive spine surgery utilizes a device which allows spine surgeons to see inside a patient's body. It is inserted through small incisions, generally half an inch wide, and the spine surgeon sees exactly what needs to be corrected without the conventional spine surgery complications. In my practice, I typically utilize an operating microscope with retractors to dramatically improve my visibility. This three-dimensional visualization allows me to perform true microsurgery. With substantially-smaller incisions and improved visibility, patients experience less pain and less recovery time thanks to greater precision. Reducing the operative field is the specialty of neurosurgeons; we're trained beginning in our first year of residency - literally on Day One - to perform microsurgery, as it's integral to the educational process of neurosurgical training. This is in contrast surgeons who use an endoscope, which only provides one dimension of visibility. The benefit of minimally-invasive spine surgery is, primarily, the healing process. After a few months, the surgical wounds are hardly noticeable, as compared to a traditional spine surgery with a large, noticeable scar. In my practice, the benefits extend beyond "just" healing. Because my patients are not operated on with the assistance of residents who are training to become adept at spine surgery, my procedures are done much more rapidly - which further reduces the risk of infection and complications.
Dr. Kapil Moza, MD, FACS, Diplomate - American Board of
Neurological Surgery 805-497-3622

How can I reduce my menopausal symptoms of dryness?

Well, you could opt for hormone treatments or personal lubricants, with the former having less-than-desirable side effects and the latter being inconvenient and sometimes uncomfortable. My clients have chosen a different method to improve intimacy and comfort - and to feel feminine again. ThermiVa is a non-hormonal, totally non-invasive treatment that significantly improves not only menopausal dryness but also the tightness and tone of the vaginal area. The treatment is performed in-office and requires no down time. Patients can see and experience significant improvements after just the first visit. Three treatments over a period of three months are recommended to produce optimal results. Tightening occurs because radiofrequency waves increase blood flow, which supports new collagen production and increases the synchronization of muscle contractions of the vaginal wall and pelvic muscles. The result is improved control of urine and stress incontinence, increased intimate satisfaction and noticeably more vaginal moisture.
Dr. Courtenay Poucher of Aesthetic Center of Santa Clarita 312-0497

I've had three babies. I don't have much belly fat but I do have loose skin, stretch marks and a puffy belly button. I would be open to a tummy tuck but I have also thought about liposuction. What's best?
This is a common issue seen after birth of multiple children. Basically, it is important to understand that we all have two rows of muscles in our belly attached to each other by a sheet of tissue. With pregnancy, this tissue is stretched permanently, leaving a loss of core strength, noticeable bulge and even hernia. To fix this issue the muscles need to be brought back together. This will recreate the curves on your sides and flatten your belly on side view. The other component that can only be addressed in an exam is how much extra skin is left. If minimal, then a mini tummy tuck is sufficient. A tummy tuck serves to excise the majority of stretch marks and has the added benefit when performed with my technique of lifting the outer thigh, too. Often liposuction, or liposculpture, can be combined with a tummy tuck to remove excess fat. However, when used by itself it relies on the skin elasticity to contract and does not address the underlying muscles, as in your case.
Dr. Justin Heller of Heller Plastic Surgery 233-4949

My husband and I have been married eight years and love each other very much. We have three children and both work hard. My problem is that the intimacy is gone in our marriage, or at least has gotten stale.
Your problem is common and quite salvageable. Most couples with children are always on the go and put themselves and their relationship last. That's a big mistake! The relationship has to be a priority - it's good for you and good for the kids. Studies show that intimacy is crucial to a good marriage. Here are a few ways to do this.

Number one: Take 30 minutes a day to talk to each other, not about scheduling or housekeeping stuff! Just eye-to-eye chatting about who you are, what you're thinking, how you're changing and what your hopes and dreams are. Yes, like a real date! This should happen without TV or cell phones vying for attention, with the kids in bed or busy and respecting "mommy and daddy" time. Talk to each other and listen to each other with compassion.

Number two: Most people think physical intimacy should happen at night. Not necessarily. That's when you're the most drained. If you can, set aside time in the morning - wake up a little earlier. That's when testosterone is the highest and you're ready to start a wonderful day. A few sessions with a sex therapist is always a great shot in the arm and can be lots of fun, too!
Dr. Judith Curts, PhD, LCSW 754-4022
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