anatomic problems in the nose that cause functional problems that most insurance companies will cover.  If you broke your nose and it causes you to have trouble breathing, insurance will usually cover the surgery to straighten it.  If you have a deviated septum or large turbinates (the pink ball like structures that hang down in your nose) that impairs your breathing insurance will usually cover surgery to straighten the septum and reduce the turbinates.

Many patients who need surgery for breathing problems also desire cosmetic changes to their nose since they’re being operated on in that area.  Some of these things are taking down a nasal hump, refining the tip, making the nose more narrow, or making the tip less bulbous.  The insurance will usually cover the part of the surgery that is medically indicated, but patients will have to pay out of pocket for any additional cosmetic work that is performed.  I always advise patients check their out of pocket expenses and deductible and co-insurance fees with their insurance companies to see exactly what is covered since every plan is different. However, because some of the surgical, anesthesia and operating room time expenses are covered, it does help the patients with the overall cost compared to paying everything out of pocket.

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I would like all my patients to know that I only use FDA-approved Botox purchased directly from Allergan, a licensed U.S. supplier.  I never believe on compromising safety or quality when it comes to my practice.  As a consumer, try to watch out for ads where Botox is extremely cheap – it may have come from a discounted foreign supplier.  Never hesitate to ask or even to see the bottle.

However, Botox itself, when used by an experienced injector and purchased legally from Allergan, is safe, FDA approved and produces great results.  Over 11 million people have used it to treat wrinkles had have younger looking skin.

Dr. Catherine Begovic

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I use it in almost all my facelifts to fill in hollows of the cheeks and to plump up the cheekbones since aging is not only a result of gravity, but also fat loss.  Fat contains stem cells, and though it hasn’t been scientifically proven – anecdotally, many of my patients see restorative effects on the skin.

I also use fat in large volumes for Brazillian Butt Lift.  This enhances the shape of the buttocks and provides more volume and creating a lift.  I also use fat grafts to fix dents and irregularities on poorly done liposuction – almost 20% of my practice is repairing liposuction on patients who come to me after having liposuction done elsewhere.

Fat is also used for natural breast augmentation.  It creates a natural look and can help patients who don’t want implants to achieve about a cup size increase.

One of the places you might not expect fat to be placed is the hands.  Fat transfer to the hands helps fill out the hollowing that occurs with age and smoothes out the appearance of veins.  Patients feel it improves the appearance of the skin.

Fat grafting takes a high degree of technical skill to ensure that the grafts take and to minimize complications.  Each micro-droplet of fat must be placed in a different layer of tissue and in even, small amounts to survive and get it’s own blood supply.  Improper placement can result in fat necrosis or poor take.  However, when properly done and shaped, fat can be used in many different places in the body to create lasting effects.

Dr. Cat Begovic



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The reason why this is important is because capsular contracture – scar tissue formation around breast implants is one of the most problematic complications of breast augmentation surgery and it occurs in 10-15% of all women usually resulting in reoperation.  Capsular contracture has been in part attributed to a biofilm of bacteria formed around the implant.  Therefore minimizing bacterial contamination should help prevent capsular contracture.

Also use of Adam’s solution – a triple antibiotic solution of cefazolin, gentamamicin and bacitracin – has been shown to decrease capsular down to 1.8 % in study groups.² I use Adam’s solution to clean out the breast pocket, clean all surgical instruments involved in implant placement, clean the breast skin, soak the implant, and also fill the Keller funnel with it.  I use it everywhere I can.

It has also been shown that exposed nipples are sources of implant bacterial contamination during breast augmentation.³ The terminal ducts at the nipple and areola are colonized with bacteria.  Therefore, I cover the nipples with a Tegederm nipple shield during the surgery to decrease the chance of bacteria from the nipple spilling into the surgery site.

I also make sure the breast pocket is completely free of any blood and minimize any instruments used and don’t put gauze or lap pads into the pocket during surgery even though there haven’t been any good clinical studies to prove that these steps help.  I may be excessive and obsessive about all these little things, but as a woman with implants myself – my greatest fear is capsular contracture, which can occur even years after the surgery – so I try to do everything possible to try to prevent it’s occurrence.

- Dr. Catherine Begovic

References:

1.  Moyer HR, Ghazi B, Saunders N et al., Contamination in smooth gel breast implant placement:  testing a funnel versus digital insertion technique in a cadavar model.  Aesthet Surg J. 2012 Feb;32(2):194-9.

2.  Adams W, Rios J, Smith S et al.  Enhancing Patient Outcomes in Aesthetic and Reconstructive Breast Surgery using Triple Antibiotic Breast Irrigation:  Six-Year Prospective Clinical Study.  Plast Reconstr Surg. 2006;118(7 Suppl):45S-52S.

3.  Wixtrom R, Stutman RL, Burke RM et al., Risk of Breast Implant Bacterial Contamination from Endogenous Breast Flora, Prevention With Nipple Shields, and Implications for Biofil Formation.  Aesthetic Surg J.  2012: Sept 10 [epub ahead of print]

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Now, every woman’s anatomy is variable but in general, most women do not like having their labia minora protrude and hang.  This can become more noticeable after pregnancy.  Sometimes, women are born with significant asymmetry between labia – one is much larger than the other.   Most of my patients feel self-conscious because there is a bulge in clothing and they cannot wear leggings, workout clothes.  One of my patients even had pain when wearing jeans because of the excess tissue.  Many patients complain of discomfort during common activities like exercising or riding a bike.  Women also feeling self-conscious during intimacy and seek surgery for that reason.  Many women don’t know that there is a surgical procedure that can help them – even some of my medical colleagues don’t know that this is done.

However, this procedure is more common than you think.  The first vaginal cosmetic surgery was performed in 1984 and in the last 10 years it has doubled.  I know it sounds like a painful surgery, but my patients are usually pleasantly surprised at how quickly they recover. I recently authored a book chapter in the “International Textbook on Aesthetic Surgery” on “Female Vaginal Cosmetic Surgery” which describes in detail the steps of different techniques.  In general, the excess labia is carefully trimmed and shaped.  The surgery takes about 2 hours.  The suture line is hidden along the inner edge of the labia.  All sutures are dissolvable so they don’t need to be removed after surgery.  Most of the swelling goes down in just a few weeks and patients can return to normal activities within a month or so.  These are some of my happiest patients who wish they had had the surgery done years ago!

- Dr. Catherine Begovic

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breast feeding, breast augmentation

I recently spoke with a friend who is a newborn ICU nurse who asked me whether or not woman were able to breast feed after breast augmentation surgery.  She told me that the nurses in her hospital were not encouraging post breast augmentation patients to breastfeed because they thought they weren’t able to.  In a study performed by Mentor as part of their FDA post-approval study, only 8% of women who had breast implants had trouble breast feeding.  Although I always tell my patients there is a possibility their breast augmentation surgery can impair their ability to breast feed, most women are able to breast feed after their surgery (including myself!), so they should definitely be encouraged to try.

Another study presented at the American Society of Plastic Surgeons annual conference found that many women who had breast augmentation surgery were concerned that breast feeding may alter the appearance of their breasts and this contributed to their trouble with and reluctance to breastfeed.  However, although breasts generally sag with each pregnancy, there is no evidence that breastfeeding worsens these effects in women whether or not they have implants.

Also, for women with silicone implants, there is a concern whether the silicone passes orally to their child in breast milk.  Multiple studies have shown that the amount of silicone in breast milk from women with silicone implants is not statistically significantly higher than breast milk from women without implants.  In fact, the levels of silicone found in grocery store cow’s milk (709 ng/ml) and infant formulas (4402ng/ml) was significantly higher than breast milk even from women with implants (55ng/ml)!

Dr. Catherine Begovic

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Fat is first harvested by liposuction from different areas of the body, separated out, and then injected carefully into the buttocks to shape it.  As the buttocks gains greater fullness in the desired areas, it pulls up the lower portion of the buttocks, creating the lift.  Because it is combined with liposuction to other areas – usually the flanks or abdomen – the final result is an overall much more aesthetically beautiful body. The ideal shape feminine shape is a thin waistline and a back that curves gently into a full buttocks.

I consider this surgery and all body sculpting surgeries to be an art.  After a Brazillian Butt Lift, patients have really enjoyed their new curves and the way they fit better in their clothes.

Dr. Begovic

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I’ve operated on many couples who underwent their plastic surgery together.  For most couples, they are able to provide support and understanding through each other’s procedures.  Sometimes they have surgery the same day, but in most cases that they choose different days so they can take turns taking care of each other.  Couples also come in together  for office procedures like botox or filler.  Regardless, couples plastic surgery is becoming increasingly more common as men are having more plastic surgery procedures.  According to the American Society of Plastic Surgery, last year, 9 percent of cosmetic procedures, around 1,194,000 were performed on men.  In my practice, being in Los Angeles, where men are more open to plastic surgery, the percentage is even higher.

I personally enjoy taking care of couples as patients, especially being married myself.  Their overall experience is usually greatly enhanced by sharing it with their partner and it’s a privilege for me to be a part of.

Dr. Catherine Begovic

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The CDC (Centers for Disease Control) has been investigating potential exposure risks of patients to Hepatitis B and C and HIV due to unsafe injection practices.  Since 1999, more than 125,000 patients in the United States have been notified of potential exposure to Hepatitis B, Hepatitis C or HIV because of syringe sharing.  It is a misconception that changing the needle is sufficient to prevent disease transmission.  Botox and other cosmetic injectables are listed by the CDC as medications commonly misused with syringe sharing.

Please don’t share your syringes or if your doctor appears to be using a pre-filled syringe to inject you, please speak up to make sure it wasn’t already used by someone else.  This will protect you from contracting any potentially harmful diseases.

Dr. Catherine Begovic

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Photo courtesy of Radar Online

Timmie Jean Lindsey is now an 80 year old great grandma.  She was the first patient to receive silicone breast implants in 1962 from the surgeon who invented them.  Amazingly enough, her original implants have never leaked or ruptured, but she does have some scar tissue.  She said that her breast tissue only started to sag when she turned 70.

She feels fortunate to have participated in the evolution of breast implants especially when one of her granddaughters had to have breast reconstruction after a double mastectomy for breast cancer.  She was happy that her granddaughter and other breast cancer survivors are able to feel whole again after breast cancer surgery.

As with any medical device, the current silicone breast implants have undergone extensive testing and FDA approval.  They have undergone major improvements since their first appearance in 1962.  We have to thank Great Grandma Timmie for being the first one to undergo this surgery which has allowed so many women to enjoy a fuller, more feminine shape.

Courtesy of Mentor Worldwide

Dr. Cat Begovic

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