Ask the Plastic Surgeon

Q : I'm interested in having my breasts enlarged. A couple  of my friends have told me that I don't need to have implants. They say that it is possible for the doctor to enlarge my breasts by injecting my own fat into them. It sounds a bit bizarre, but it would seem to be a good solution if it actually works. What can you tell me?

A :Your friends are right. Recently there has been quite a bit of interest in doing breast enlargements by transferring fat from other body locations, like the abdomen or buttocks. However there is little evidence to show that a significant amount of fat can be transferred and survive to produce a larger breast. Another point of concern is that we do know that fat injections can cause oil cysts, calcium deposits and scarring within the breast. These changes can mimic what is seen when breast cancer develops. Advances in digital mammography have led some radiologists to believe that they can distinguish between the changes caused by fat injections versus cancer, but there's still a risk. Speaking of risks, there is no evidence that fat injections are safer than silicone or saline breast implants. At this point in time, my advice to you is to wait on fat injections for breast enlargement until your doctor can show you the scientific studies that conclude that it is safe, effective and not likely to be confused with breast cancer. As I tell all of my patients, "the latest isn't necessarily the greatest!"

Q: My hands are starting to go to sleep when I'm driving, and I'm waking up at night with them tingling. I've been told I have carpal tunnel syndrome. Do I really need surgery, and, if so, what kind of surgeon is best trained to help me, a plastic surgeon or an orthopedic surgeon?

A: From the symptoms that you describe, it sounds like you do have pressure on one of the major nerves to your hands. Most often this results from pressure on the nerve at your wrist. Conservative treatment, like using wrist splints at night, can sometimes allow the problem to resolve without an operation. It also helps to keep your wrists supported when working on the computer. If the non-surgical measures don't help, then you should consider talking with a surgeon. If there is any question about the cause of your problem, your family doctor or internist can arrange for nerve and muscle testing to confirm that you do indeed have carpal tunnel syndrome. The actual, corrective surgical procedure can be done by either a plastic or orthopedic surgeon who specializes in surgery of the hand. I applaud your question. Many people do not know that plastic surgeons are often times hand specialists, given the intricacies of the surgeries that they are trained to perform. 

Q: I have been reading about serious problems with Botox injections and that people have even died! I'm very happy with the reduction in facial wrinkles from the Botox I've been getting, but it still worries me to hear about these problems. My plastic surgeon tells me it's still safe; do you agree?

A: Potential adverse events and complications are possible with any procedure that involves the injection of drugs or other substances. It is important to speak at length with your doctor, prior to having any substance injected, so that you can be fully informed about the potential side effects and complications. For instance, drooping of the eyebrows, a reaction at the injection site, and weakness of the lips or mouth can all occur when using Botox. This brings up the point that a board-certified plastic surgeon, with training in all of the intricacies of the face, increases your odds of having a successful outcome. The more serious complications that you reference (death) did not occur with Botox. There have been reported human uses of botulinum toxin which is a substance intended for animal experiments. This usage has produced significant complications, so you may want to confirm that you are receiving BotoxÆ Cosmetic which is approved for cosmetic usage. The safety record for Botox is very good. It has been used for nearly 20 years, literally millions of times. So, I would agree with your doctor that Botox, used by appropriately trained and educated medical doctors, is safe. Not without any risks, but nevertheless, relatively safe.

Dr. Robert A. Laughlin is a board-certified plastic and reconstructive surgeon who has been helping people from all over the world for the past 26 years. His practice, Hilton Head Island Plastic Surgery, is located on the campus of the Hilton Head Regional Medical Center where he is a member of the Board of Directors and the active surgical staff.
Dr. Laughlin lives on Hilton Head with his wife Linda, who is also his surgical assistant. They have two grown daughters and four grandchildren. He may be reached at (843) 681-4088 or

Questions should be emailed to his address at This email address is being protected from spambots. You need JavaScript enabled to view it.. Readers should include "Pink" in their subject line.

If your question is selected for publication, your name will remain  confidential and will not be used in the column. This column is for  informational purposes only and not intended to take place of a medical consultation with a qualified physician.

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