BREAST AUGMENTATION CONTINUES TO BE ONE OF THE MOST POPULAR COSMETIC SURGICAL PROCEDURES.  SILICONE GEL IMPLANTS ARE BEING USED IN ABOUT HALF OF THOSE PROCEDURES.  GEL IMPLANTS OFFER SUPERIOR NATURALNESS, SOFTNESS AND SIGNIFICANTLY LESS PALPABILITY THAN SALINE IMPLANTS.  THE SILICONE FEAR IS NOT TOTALLY FORGOTTEN AND CAN MAKE THE DECISION OF WHICH IMPLANT TO GO WITH MORE DIFFICULT.  FORTUNATELY, THERE HAS BEEN NO SCIENTIFIC EVIDENCE THAT SILICONE IS HARMFUL.  THE REMAINING CONCERN IS KNOWING WHEN A GEL IMPLANT NEEDS TO BE REPLACED.  THE FDA RECOMMENDS EVERY TEN YEARS. THIS IS A VERY CONSERVATIVE AND SAFE RECOMMENDATION.  HOWEVER, COST IS AN ISSUE.  THE SILICONE GEL IMPLANTS ARE NOT CHEAP.  SHOULD WOMEN KEEP A BREAST FUND?

THE PLACEMENT OF THE BREAST IMPLANT IS ALSO CONTROVERSAL.  IN MY OPINION, ALL SALINE BREAST IMPLANTS NEED TO BE PLACED UNDER THE MUSCLE.  WHY?  THEY WILL ALL EVENTUALLY HAVE VISIBLE RIPPLING.  IT IS DIFFICULT TO PREDICT WHEN AND WHERE ON THE BREAST IT WILL OCCUR.  BUT IF THE RIPPLING BECOMES VISIBLE IN THE CLEAVAGE AREA A REVISION WILL BE NEEDED.

GEL IMPLANTS HAVE MORE OPTIONS.  SOFT TISSUE COVERAGE IS THE MOST IMPORTANT FACTOR IN DETERMINING THE APPROPRIATE PLACEMENT.  INADEQUATE SOFT TISSUE COVERAGE REQUIRES SUBMUSCULAR PLACEMENT.  WHY?  WELL, GEL IMPLANTS CAN ALSO RIPPLE.  SUBMAMMARY (UNDER THE BREAST TISSUE) CAN BE SUBGLANDULAR OR SUBFASCIAL.  THE ADVANTAGES OF SUBMAMMARY PLACEMENT INCLUDE LESS POSTOPERATIVE PAIN, FASTER RECOVERY,  A MORE NATURAL RESULT, NO MUSCLE CONTRACTION CONCERNS (WHICH IS BETTER IN THE COMPETITIVE ATHLETE) AND OBTAINING THE FINAL APPEARANCE MORE RAPIDLY.  THERE HAVE BEEN CONCERNS WITH AN INCREASED CAPSULAR CONTRACTURE RATE AND DIFFICULTIES PERFORMING A THOROUGH MAMMOGRAM.  THESE CONCERNS ARE REAL.  BUT CONTRACTURES CAN BE MINIMIZED WITH POSTOPERATIVE DISPLACEMENT EXERCISES. MAMMAGRAMS REQUIRE ADDITIONAL COMPRESSION VIEWS.

SUBFASCIAL PLACEMENT IS A CONTROVERSIAL APPROACH.  I FAVOR THIS APPROACH OVER A SUGLANDULAR APPROACH IN MY PATIENTS.  I FEEL THIS APPROACH OFFERS A DECREASED CAPSULAR CONTRACTION RATE AND LESS RISK OF PALPABILITY MAINTAINING ALL THE ADVANTAGES OF SUBMAMMARY PLACEMENT.  MORE CONTROLLED STUDIES WITH LONG TERM RESULTS WILL BE NEEDED TO SETTLE THIS CONTROVERSY.

PERMALIP IS A NEW MEDICAL DEVICE FOR PERMANENT LIP AUGMENTATION.  LIP AUGMENTATION CAN BE EITHER TEMPORARY OR PERMANENT.  TEMPORARY LIP AUGMENTATION CAN BE PERFORMED WITH ONES OWN FAT OR NUMEROUS FILLERS.  THESE TREATMENTS ARE OFTEN PAINFUL, NEED TO BE REPEATED, ARE COSTLY AND UNPREDICTABLE AS FAR AS LONGEVITY.  SURGISIL HAS DEVELOPED A FDA  APPROVED PERMANENT IMPLANT MADE OUT OF A SOFT SILICONE POLYMER.

I HAVE HAD THE OPPORTUNITY TO TRIAL THIS PRODUCT WITH GREAT SUCCESS.  THE PATIENT HAD A VERY NATURAL UPPER AND LOWER LIP AUGMENTATION.  THE RECOVERY WAS PROBLEM FREE WITH A SHORT PERIOD OF DOWN TIME. THE RESULT HAS REMAIN SOFT AND NATURAL.  I AM HAPPY TO BE ABLE TO OFFER THIS PRODUCT TO MY PATIENTS AS ANOTHER OPTION FOR PERMANENT LIP ENLARGEMENT.

BOTOX IS THE NUMBER 1 COSMETIC PROCEDURE BEING PERFORMED WORLDWIDE.  DR. KOCH HAS BEEN USING BOTOX FOR OVER 10 YEARS.  HE IS THE NUMBER 1 INJECTOR OF BOTOX IN WNY.  EXCELLENT RESULTS HAVE DRIVEN THE POPULARITY OF THIS PROCEDURE.

JUVEDERM HAS BECOOME THE #1 FILLER IN THE USA.  THE POPULARITY HAS REPLACED ALL OTHER FILLERS AVAILABLE AT THE PRESENT TIME.