Ask the Plastic Surgeon

Q:    My hands really bother me at night and I've had the special nerve testing to tell me that I do have carpal tunnel syndrome in both of them.  I read that there is a newer type of surgery that uses something called an "endoscope" to allow smaller incisions and faster recovery. Which type of carpal tunnel surgery do you think is better? 

A:    Studies that compared both techniques generally show a higher complication rate associated with endoscopic surgery than with the conventional carpal tunnel surgical methods.  Assuming both surgeons have equal training and experience, I would opt for the lower chance of a complication rather than being overly concerned about scarring.  Fortunately, the conventional carpal tunnel surgery doesn't require extensive incisions and the hand and wrist heal with minimal scarring.  The recovery is about the same with either procedure.

Q :    Why does my surgeon say that I have to stop smoking before my facelift? How long do I need to abstain?

A:    The nicotine in cigarette smoke (first or second-hand), or in the gum people use to help them stop smoking, causes the small blood vessels in the skin to constrict. When a facelift is done, maintaining the blood supply to the skin is very important in order to produce prompt healing and minimal scarring. Some of the complications from smoking or consuming nicotine are: bad scarring, poor or delayed healing, hair loss, sloughing of the skin (skin loss), prolonged bruising and hyperpigmentation (darkened areas of the skin).
    Getting nicotine out of your bloodstream for 2-3 weeks prior and after your surgery will help minimize any complications in the healing process.
     Another concern is that your breathing capacity is diminished from smoking and this makes having a general anesthetic more complicated.

Q :    How do you determine the "best" implant size for a breast enlargement? What happens if, after the surgery, you think that you want to go bigger?

A:    In my office, I give my breast augmentation patients an expandable bra and have them fill the cups with different sizing implants until they achieve the size that they are looking for. In that way, I can predict with pretty good accuracy, the volume of the implant that they will need.
        It's usually not a problem to increase the size of the implants after surgery, although I usually suggest waiting a period of time for the body to recover from the initial surgery. Of course, there would be a second set of costs incurred to do another surgical procedure.

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