“Often, people use fillers because they want to restore their confidence,” said board-certified dermatologist Elizabeth Tanzi MD, FAAD, associate clinical professor of dermatology at George Washington University School of Medicine in Washington, D.C. “Fillers are a minimally invasive procedure that can help patients feel better about their skin as they age, so I recommend them for people who want to enhance their facial features.”

Fillers can restore fullness to the face, decrease fine lines, plump lips, diminish scars, and give nearly immediate results, according to the American Academy of Dermatology (AAD).

If you are considering fillers, Tanzi recommends the following tips to get the best results and avoid complications:

Choose a licensed physician. To get optimal results and protect your health, it’s important to have this procedure performed in a medical office by a licensed physician. Board-certified dermatologists have the education, training, and experience to inject fillers safely and effectively into targeted areas of the skin to create a smoother, more youthful appearance.

You can find a board-certified dermatologist who offers fillers in your area using the AAD’s “Find a Dermatologist” tool.  When searching, select “Fillers” in the “Procedure” drop-down filter menu.

To avoid complications, you should never get fillers injected in a non-medical setting, such as a party or someone’s home.

Ask to see before-and-after photos of past filler patients. You might find these on your dermatologist’s website.

Gather your medical information. Before getting a filler, it is essential that you tell your dermatologist about your medical conditions, the medicines and supplements you take, any allergies, whether you have a history of cold sores, and any previous cosmetic treatments.

Bring photos of yourself to your appointment. Showing your dermatologist pictures of yourself from a time you were happy with your appearance helps them know what you want and plan for the procedure.

Follow your dermatologist’s instructions. Your dermatologist will give you tips to follow after your appointment to help your skin heal and get the best results, along with signs you need to see your dermatologist for follow-up care.

“One of the most important things I tell patients who are interested in fillers is to remember that getting a filler is a medical procedure,” said Tanzi. “While it can be easy for patients to get caught up in the excitement of getting a cosmetic procedure, they need to remember that choosing who will perform the treatment is the most important decision in the process. I recommend that patients consult with a board-certified dermatologist as we have the skills and experience to perform the treatment safely and effectively.”

Those are common questions people have when considering breast implants.

The federal Food and Drug Administration (FDA) offers the following information to help people make smart decisions about breast implants.

The FDA has approved implants for increasing breast size, for reconstruction after breast cancer surgery or trauma, and to correct developmental defects. The FDA has also approved breast implants to correct or improve the result of a previous surgery.

There are two types of FDA-approved breast implants: saline-filled (saltwater solution) and silicone gel-filled. Both have a silicone outer shell and vary in size, shell thickness, shell surface texture, and shape (contour).

Know the Risks of Breast Implants

FDA-approved implants undergo extensive testing before approval to demonstrate reasonable assurance of safety and effectiveness. Still, there are risks associated with all breast implants, including:

Additional surgeries

Breast implant associated-anaplastic large cell lymphoma (BIA-ALCL), which is a cancer of the immune system

Systemic symptoms, commonly referred to as Breast Implant Illness (BII)

Capsular contracture (scar tissue that squeezes the implant)

Breast pain

Rupture (tears or holes in the shell) of saline and silicone gel-filled implants

Deflation (with visible change to breast size) of saline-filled implants

Silent (without symptoms) rupture of silicone gel-filled implants

Infection

The silicone used for breast implants is different than injectable silicone. Injectable silicone is not FDA-approved for breast augmentation, breast reconstruction, or for body contouring.

Breast Implants Are Not Lifetime Devices

The longer you have breast implants, the greater the chances are that you will develop complications,  the FDA says in its Consumer Update feature, and some of these will require more surgery.

The life of breast implants varies by person and cannot be predicted. That means everyone with breast implants may need additional surgeries, but no one can predict when. Patients can also request additional surgeries to modify the size or shape of their breasts.

Understand Product Labeling for Implants

To help patients be aware of the risks of breast implants before their surgery, the FDA requires that all FDA-approved breast implants include labeling with easy-to-understand information about the benefits and risks associated with the product. This requirement is intended to enhance the discussions patients have with their doctor about the benefits and risks of implants. The mandatory labeling information includes a patient decision checklist that highlights key information about risks; warning information formatted in a box to make it noticeable; and a patient device card with information specific to a patient’s implant, such as the serial or lot number and the style and size.

The FDA restricts the sale and distribution of breast implants to only health care providers and facilities that provide information to patients using the patient decision checklist. The patient must be given the opportunity to initial and sign the checklist before agreeing to surgery, and it must be signed by the physician implanting the device.

Additionally, the FDA says in its Consumer Update, patients should read the Summary of Safety and Effectiveness Data and product labeling for each implant to learn about the materials used to construct the device, device characteristics and the fillers used. The Summary of Safety and Effectiveness Data have been produced for all approved saline and silicone gel-filled breast implants. The Summary of Safety and Effectiveness Data and the product labeling provide information on the indications for use, risks, warnings, precautions, and studies associated with the FDA’s approval of the device.

The Summary of Safety and Effectiveness Data also provides information on clinical study used for device approval. The most serious complications are those that lead to further surgeries, such as ruptures or capsular contracture, or BIA-ALCL diagnosis.

Communicate with Your Surgeon

Surgeons will discuss the shape, size, surface texture, placement of the implant, and the incision site for each person. Ask your surgeon questions about their experience in performing breast implant surgeries, the surgical procedure, and the ways the implant might affect your life.

Tell your surgeon about previous surgeries and your body’s response. For example, discuss whether surgeries resulted in a more than expected amount of scar tissue. Also, discuss your expectations. These discussions will help you and the surgeon make decisions that achieve the desired appearance, including decisions about incision location and size, as well as implant size, material, texture, and placement.

Many patients have additional operations to change implant size. To achieve the best results after the first procedure, the FDA cautions, careful planning and reasonable expectations are necessary.

Know the Long-Term Risks of Breast Implants

The FDA has identified an association between breast implants and the development of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a type of non-Hodgkin’s lymphoma. Patients who have breast implants may have an increased risk of developing this cancer which mostly develops in the fluid or scar tissue surrounding the implant.

Breast implants have either smooth or textured surfaces (shells). BIA-ALCL develops more frequently in patients with textured implants than in those with smooth-surfaced implants. Like other lymphomas, BIA-ALCL is a cancer of the immune system and not of breast tissue.

Some patients with implants have also reported health problems such as connective tissue diseases (such as lupus and rheumatoid arthritis), trouble breastfeeding, or reproductive problems. There is currently insufficient evidence to support an association between breast implants and those diagnoses.

Additionally, some patients receiving breast implants have reported a variety of systemic symptoms such as joint pain, muscle aches, confusion, chronic fatigue, autoimmune diseases, and others. Individual patient risk for developing these symptoms has not been well established.

Monitor Your Breast Implants

In general, follow your surgeon’s instructions on how to monitor your breast implants.

If you notice any unusual signs or symptoms, report them promptly to your surgeon or health care provider. Health care providers and patients are encouraged to report adverse events or side effects related to the use of these products.Click here to find out more.

Also, follow your health care provider’s instructions for imaging for screening for breast cancer as this may be different for those patients who had breast augmentation and for those patients who had breasts reconstruction. If you are making an appointment for mammography, inform the mammography facility that you have breast implants, and ask them what you can expect regarding mammography with breast implants.

Your surgeon or health care provider may also recommend other tests, such as ultrasound or magnetic resonance imaging (MRI). The FDA recommends that patients with silicone implants get regular screenings to detect silent ruptures.

The best advice is not to be too hard on yourself. Go slowly. Give yourself time to return gradually to your routine and think about taking the opportunity to restructure your life and your schedule. Get help for those things you can’t do for yourself. If healthy eating and a diligent exercise regimen haven’t yielded the results you want, consider a consultation to determine if plastic surgery might provide just the boost and impetus you need to get back on track.

One solution might be found in the constellation of procedures that are known as a “mommy makeover.” Originally developed as a means to help women restore their pre-pregnancy bodies, a “mommy makeover” is a personalized combination of surgical procedures that will improve a woman’s physical and emotional health by addressing areas that are resistant to improvement from diet and exercise. A typical “mommy makeover” addresses the abdomen and/or breasts and may incorporate liposuction to perfect the final contours.

Abdomen: Many women find that diet and exercise alone cannot correct abdominal skin that is stretched out and sagging and stretch marks caused by pregnancy or previous weight gain and loss. Some women also suffer weakening of the abdominal muscles that results in a persistent bulge that resists efforts to reduce it. An abdominoplasty or tummy tuck removes excess skin and stretch marks and can also repair damaged muscles. The result is a flatter, firmer stomach and improved waistline. 

Breasts are also prone to loss of elasticity as childbearing, nursing, and aging take their toll and the breast tissue drops to the bottom of the breast, leaving the top flat and the breast sagging. Several procedures can correct problems with the breast:

A mastopexy or breast lift will not change the size of the breasts but will remove excess skin and reposition the nipple and areola higher on the breast mound or move the breast tissue itself higher on the chest wall, creating a more youthful-appearing breast. 

With or without a breast lift, some women may want to undergo a breast augmentation that places a saline or silicone gel implant under the breast tissue to increase the size of the breast.

A mammoplasty or breast reduction addresses the effects of large breasts, including back and arm pain, headaches, and a rash under the breasts. The procedure removes excess tissue and skin and positions the breast tissue higher on the chest wall. 

Liposuction can be used along with abdominal and breast procedures to perfect the final contours by removing additional fat to achieve the desired results. 

Surgery can help correct body defects caused by life changes and stress but that no one should rush into surgery without careful consideration. In particular, surgery is not a shortcut to weight loss and should not be undergone until a stable, healthy weight is achieved and the possibility of correction with exercise has been exhausted. With appropriate goals and expectations, a “mommy makeover” can help restore your pre-pandemic body along with your confidence and self-esteem. 

Constance M. Chen, MD, is a board-certified plastic surgeon with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine. www.constancechenmd.com 

Breast development in adolescence and the teen years is an important marker in the transition to adulthood for young women. At an age typified by self-consciousness about body image, coming to terms with anomalies in breast development is particularly difficult. Most congenital breast anomalies are not medically dangerous but can cause emotional distress. Fortunately, these conditions can usually be corrected surgically preempting long-lasting effects on self-esteem.

Breast development begins before a baby is born and while some congenital anomalies may be evident at birth, others may not become apparent until later in childhood or at puberty. While genetic factors sometimes play a role, the cause of most of these disorders is unknown. Many differences that may be initially worrisome – like breast buds of different sizes or breasts that develop at different rates – are part of normal development and may resolve on their own. In these cases, surgical intervention is best delayed until development is complete. In all cases, treatment will depend on the severity of the deformity and its psycho-social effects.

Hypoplastic breast is a condition in which one or both breasts don’t develop normally during puberty. The result may be severely asymmetrical breasts or, if both breasts are involved, very small breasts that are out of proportion with the woman’s body. While most women with hypoplastic breasts have normal hormone levels, hormone production or regulation sometimes play a role and can affect lactation. Treatment for hypoplastic breast is generally breast augmentation of the underdeveloped breast(s) with implants or by using a woman’s own tissue (“autologous reconstruction”), usually taken from the abdomen, to fashion a new breast. These techniques are similar to those used for cosmetic augmentation or for breast reconstruction when a woman has lost a breast to mastectomy. When only one breast is hypoplastic, another option is to achieve symmetry by reducing the fully developed breast (“reduction mammoplasty”). 

Poland syndrome, first described by a19th-century doctor, is a congenital syndrome that develops in the first six weeks after conception and typically involves missing or underdeveloped chest muscles on one side of the body. The characteristics of Poland syndrome can vary widely and may include, in addition to an underdeveloped breast, abnormalities of the chest wall, the ribs, the arm, and the hand. Treatment is generally via reconstructive surgery and depends on the severity of the condition. 

Tuberous breast deformity (also known as constricted breast) results in one or both breasts failing to develop normally during puberty. In mild cases, the affected breast may just be smaller. In more severe cases, the base of the breast may appear constricted, with less skin and volume along the crease, the crease may be positioned too high on the chest wall, or there may be bulging (herniation) of breast tissue through the areola. Treatment may include expanding the constricted breast base, lowering the crease, adding volume and skin, and reconstructing the nipple-areola complex. 

Supernumerary breast tissue may develop in the embryo and cause breast tissue to be found outside its normal location on the chest, anywhere from the abdomen to the armpit. The tissue may be just a small nipple or a large amount of tissue. Treatment isn’t always necessary but depending on its location and the discomfort it causes, the tissue can be surgically removed. Polymastia (an extra breast) and polythelia (an extra nipple) can similarly be treated with surgical removal.  

Correcting congenital breast deformities is often driven as much by psychological and social motivation as by medical necessity. Consultation with a plastic surgeon can help every woman evaluate her options, set appropriate expectations, and make the decision that is right for her.”  

Constance M. Chen, MD, is a board-certified plastic surgeon with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine. www.constancechenmd.com 

Many women are able to live with their implants for many years, but some become dissatisfied with the way their breasts look and feel and may suffer from various complications. Implant removal can sometimes address these issues. However, what we’re seeing now is concern about serious illnesses and women want to know if they should prophylactically have their implants removed to prevent these conditions.

There is no definitive clinical diagnosis of breast implant illness (BII). It comprises many symptoms, including brain fog, fatigue, and joint pain that can’t be tested for or seen on an X-ray or in a physical examination. Women also complain of breast pain, hair loss, rashes, and muscle pain. Many doctors do not believe that BII exists and may downplay women’s complaints despite the fact that many of the symptoms are relieved by implant removal. Implants are foreign bodies, and the introduction of any foreign material into the body provokes a natural response that can cause a wide range of problems.

Many of the reported symptoms are also common to autoimmune and connective tissue diseases such as rheumatoid arthritis and lupus, which have long been controversially suspected of linkage to breast implants. With research under way, the FDA has issued a black box warning about the risks of breast implants, but they continue to stay on the market. Women suffering symptoms are advised to consult with their doctors about the advisability of having them removed. Those with no symptoms may also want to talk to their doctors even if they have no compelling reason to have their implants removed.

Apart from BII, there is a known link between breast implants and anaplastic large cell lymphoma (ALCL). It is very rare, and there is an increased risk associated with Allergan brand implants that have a rough or textured surface. For this reason, all Allergan textured implants were taken off the market by the manufacturer.

Anaplastic large cell lymphoma is a rare type of non-Hodgkin lymphoma that is a cancer of the immune system. It is usually slow-growing and treatable. When ALCL is associated with breast implants, it is not cancer of the breast tissue but is located in the scar tissue, or capsule, that naturally forms around the implant. The most common symptom is swelling of the breast that usually occurs over several years after placement of the implant due to the accumulation of fluid around the implant or a mass on the capsule. This may occur two years or twenty years later but on average, this swelling occurs after the implant has been in place for eight to 10 years. Women with implants who notice swelling, fluid buildup, or any change in the shape of the breast, should see their plastic surgeon. If Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is diagnosed through imaging and testing of the fluid around the breast, treatment is the surgical removal of the implant and the entire capsule that surrounds it. In its early stages, complete capsulectomy is usually curative. Further treatment is necessary only if all the cancer could not be removed or if the disease has spread to the lymph nodes or other parts of the body. In these cases, women with advanced BIA-ALCL may need chemotherapy or radiation treatment. There have been 33 deaths due to BIA-ALCL.

Researchers don’t know yet why a textured surface increases the risk of cancer but they theorize that the texturing may create particles that cause abrasions that trigger the immune system to respond and then, over time, to malfunction. Another theory is based on the possibility that bacteria on the surface cause infection. It’s possible that there are multiple factors, including the patient’s genetic makeup, that contribute to the risk of cancer. To date, the textured surface is the primary risk factor, although there have been reported cases in smooth shell implants. There appears to be no difference in risk in implants filled with silicone or saline.

Even with the knowledge that the risk is greater than previously known, BIA-ALCL is still rare. Women with breast implants should have routine periodic follow-up exams as determined by their doctors, should examine their breasts monthly, and should seek immediate care for any changes in the breast.

Constance M. Chen, MD, is a board-certified plastic surgeon in New York City with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She operates at Lenox Hill Hospital, and holds appointments as Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine. www.constancechenmd.com 212-792-6378

The elective medical procedure was prohibited in most states throughout the peak months of the pandemic, but the phasing in of business reopenings has brought it back. Daily operations won’t be the same as before, though, due to heightened health priorities.

It will seem and look a little different when a patient visits the office, but the approach by the professional should always be the same: patient first. Plastic surgery requires head, heart, and hands. Head for knowledge and vision, heart for empathy, hands for technical expertise.

Patient safety is always No. 1, but now it’s incumbent on all surgeons to ensure they and their staff leave no stone unturned when it comes to keeping their facility clean. Strict and consistent health and safety practices have to be followed every day.

These are the safety protocols patients should now expect at a plastic surgery facility:

• Pre-screening before arriving.

  Several days before a scheduled surgery, patients are pre-screened to go over their recent health. It includes whether they have had any COVID-19 symptoms such as fever, sore throat, difficulty breathing, loss of smell/taste, etc. Additionally, you need to know if they’ve traveled anywhere in the U.S. or abroad in the previous three weeks, or if they’ve had any contact with people who had symptoms. They’ll also fill out a form including these kinds of questions when they arrive.

• Increased sanitization.

  Regular and deep sanitization efforts to keep the facilities as germ-free as possible are essential. This includes continually disinfecting common areas and high-touch surfaces, starting from the front-office check-in area to each treatment and exam room before and after each patient interaction. Medical-grade air purifiers that circulate the air are very important. There are also machines that create a suction field over the head of a patient who is receiving facial injectables, clearing the air of potentially infectious particles.

• Strict adherence to CDC recommendations.

  All patients should be temperature-screened when they arrive. And like many medical and dental offices, plastic surgery facilities are limiting and staggering appointments to stay within social distancing guidelines, keeping their waiting rooms mostly sparse. New patients’ first consultations are often done by video conference. Also, patients should wait in their cars until the staff is ready for their appointment.

• Wearing full PPE gear.

  Providers and their staff will have to completely safeguard themselves and patients with increased personal protection  Everybody wears N95 respirator masks, gloves, scrubs, gowns and eye protection during direct patient contact. For procedures such as lip fillers, wearing an N95 mask, the surgeon’s approach is from above and the side, thus preventing close face-to-face frontal exposure and avoiding droplets in either direction.

People will keep wanting to help their appearance, to get a renewed look back. The various ways of cosmetic surgery can still be done safely, and that’s a team effort among patient, doctor, and staff. Everybody has to pay careful attention to ensure safety.

Scott  R. Miller M.D. FACS (www.MillerCosmeticSurgery.com) is a board-certified cosmetic and reconstructive plastic surgeon and the founder of Miller Cosmetic Surgery Center. He earned his medical degree from the University of California Irvine, College of Medicine and performed his plastic surgery residency at the University of California San Diego, School of Medicine. Dr. Miller took a prestigious Aesthetic Surgery Fellowship with world-renowned plastic surgeon Bruce Connell, M.D.; is an attending surgeon at Scripps Memorial Hospital in La Jolla, Calif.; and a voluntary clinical instructor and assistant professor of plastic surgery at the University of California, San Diego. A sought-after speaker, he has published numerous scientific articles and textbook chapters and has been honored many times for his contributions to aesthetic surgery.

In October 2019, the United States Food and Drug Administration (FDA) released draft guidance advising that breast implant manufacturers include a black box warning on breast implants laying out the risks relating to breast implants and autoimmune symptoms as well as a link between breast implants and a rare cancer of the immune system called Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Plastic surgeons and patients have also developed a patient decision checklist to guide conversations that surgeons have with their patients before surgery.

In May 2019, the FDA released a public letter stating that “current evidence supports that some women experience systemic symptoms, referred to by some patients and health care professionals as breast implant illness, that may resolve when their breast implants are removed. We believe women considering a breast implant should be aware of these risks.”

This FDA letter follows publication of a major study evaluating breast implant safety conducted by surgeons at the University of Texas MD Anderson Cancer Center.”A study published in the January 2019 Annals of Surgery looked at 100,000 women with either saline-filled or silicone breast implants. There was a correlation between silicone implants and six to eight times higher rates of Sjogren syndrome, an immune system disorder; scleroderma; and rheumatoid arthritis; as well as three to four times higher rates of stillbirth and melanoma, a skin cancer.

A study published in the December 2018 International Journal of Epidemiology also found a 22% greater likelihood of autoimmune disease and rheumatoid arthritis in women with silicone breast implants. The study included 125,000 Israeli women, 25,000 of whom had silicone breast implants. While the studies do not prove causation, the correlation between silicone implants and autoimmune diseases is statistically significant.

Implants are foreign substances that prompt an immune response in the body. The body tries to wall off the implant by creating a capsule around it as a barrier. The capsule can be something that is soft and flimsy, almost like a film, hardly noticeable, or it can become firm and uncomfortable – even painful – and can turn into a hard shell that shrinks and contracts over time – a condition called capsular contracture.

Autoimmune disorders are conditions in which disease-fighting cells mistakenly attack an individual’s own body. The errant cells can impact a variety of tissues, including blood and muscles, or they can target specific organs like the liver and brain. Experts believe that the presence of these foreign devices can eventually overwhelm the body’s immune response, leading to autoimmune disorders.

More than 400,000 women undergo breast implant surgery annually in the United States – some for the first time and others for replacement of old implants that have either ruptured or caused other problems. Three-quarters of the procedures are intended to augment healthy breasts. The remaining cases are related to breast reconstruction following mastectomy.

Adjuvant effects of silicone toxicity have been the focus of several studies, including one by Case Western Reserve and the Armed Forces Institute of Pathology, showing evidence of silicone in the lymph nodes of women with breast implants. The long-term health risks of these migrating silicone particles remain unknown, experts say. Meanwhile, research by the National Cancer Institute has determined that women with breast implants have as much as a 21 percent increased risk of developing various cancers, including neoplasms of the brain, respiratory tract, cervix and vulva.

Most women find that their health improves dramatically after their breast implants are removed. Women discover that their chest tightness and arm pain is resolved, their energy returns, their skin problems disappear, and they can think more clearly. Often, the difference is immediate, and patients marvel that symptoms that plagued them for years disappear completely.

For patients who must undergo mastectomy or are simply considering implants for cosmetic reasons, I offer this advice:

• Know the risks. Most implants eventually need to be replaced or removed.
• Find a breast and plastic surgery team skilled in the most advanced procedures and knowledgeable about the pros and cons of the latest innovations in breast surger
• If discomfort, pain or illness-like symptoms develop seemingly as a result of the implants, it is possible to remove the implants in an en bloc total capsulectomy, in which the surgeon carefully removes the implant with its capsule in one piece without allowing capsule contents to spill and contaminate the chest cavity.

Breast implant illness is still not well understood or accepted in the medical community. Women often feel like they are going crazy, even as they know that something is wrong. The good news is that a majority of women with breast implants experience significant relief and resolution of symptoms when their implants are removed properly. Women need to be aware so that they can take control of their own bodies.

Constance M. Chen, MD, is a board-certified plastic surgeon in New York City with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She operates at Lenox Hill Hospital, and holds appointments as Clinical Assistant Professor of Surgery (Plastic Surgery) at Weill Cornell Medical College and Clinical Assistant Professor of Surgery (Plastic Surgery) at Tulane University School of Medicine. www.constancechenmd.com

Those are common questions people have when considering breast implants.

That’s why the U.S. Food and Drug Administration offers (FDA) the following information to help people making decisions about breast implants.

Breast implants are medical devices implanted under the breast tissue or chest muscle to increase breast size (augmentation) or to replace breast tissue that has been removed because of cancer or trauma, or that has failed to develop properly because of a severe breast abnormality (reconstruction).

The FDA has approved implants for increasing breast size in women, for reconstruction after breast cancer surgery or trauma, and to correct developmental defects. Implants are also approved to correct or improve the result of a previous surgery.

The FDA has approved two types of breast implants: saline-filled (salt-water solution) and silicone gel-filled. Both have a silicone outer shell and vary in size, shell thickness, shell surface texture, and shape (contour).

FDA-approved implants undergo extensive testing before approval to demonstrate reasonable assurance of safety and effectiveness. Still, there are risks associated with all breast implants, including:

Additional surgeries

Breast implant-associated-anaplastic large cell lymphoma (BIA-ALCL), which is a cancer of the immune system

The longer you have breast implants, the greater the chances for complications.

Systemic symptoms, commonly referred to as Breast Implant Illness (BII)

Capsular contracture (scar tissue that squeezes the implant)

Breast pain

Rupture (tears or holes in the shell) of saline and silicone gel-filled implants

Deflation (with visible change to breast size) of saline-filled implants

Silent (without symptoms) rupture of silicone gel-filled implants

Infection

The silicone used for breast implants is different than injectable silicone. Injectable silicone is not FDA-approved for breast augmentation, breast reconstruction, or for body contouring.

The longer you have breast implants, the greater the chances are that you will develop complications, some of which will require more surgery.

The life of breast implants varies by person and can’t be predicted. That means everyone with breast implants can face additional surgeries, but no one can predict when. Patients can also request additional surgeries to modify the aesthetic outcome, such as size or shape.

The FDA advises that people considering breast implants look at the Summary of Safety and Effectiveness Data for each implant to learn about the materials used to construct the device, device characteristics and the fillers used. These summaries have been produced for all approved saline and silicone gel-filled breast implants. The Summary of Safety and Effectiveness Data and the product labeling  provide information on the indications for use, risks, warnings, precautions, and studies associated with FDA approval of the device.

They also provide information on how often serious complications occurred. The most serious complications are those that lead to further surgeries, such as ruptures or capsular contracture, or BIA-ALCL diagnosis.

The FDA advises surgeons to give people the full product labeling, including all of the patient information from the manufacturer, for implants. Ask your surgeon for the most recent version of the labeling, and read it carefully. If you have questions about any of this information, ask your surgeon.

Surgeons evaluate the shape, size, surface texture, and placement of the implant and the incision site for each person. Ask your surgeon questions about his or her experience in performing breast implant surgeries, the surgical procedure, and the ways the implant might affect your life.

Tell your surgeon about previous surgeries and your body’s response. For example, discuss whether surgeries resulted in a larger than expected amount of scar tissue. Also, discuss your expectations. These discussions help the surgeon make operative decisions that achieve the desired appearance, including decisions about incision location and size, as well as implant size, material, texture, and placement.

Many people have additional operations to change implant size. To achieve the best results after the first procedure, careful planning and reasonable expectations are necessary.

The FDA has identified an association between breast implants and the development of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a type of non-Hodgkin’s lymphoma. People who have breast implants may have an increased risk of developing this cancer in the fluid or scar tissue surrounding the implant.

Breast implants have either smooth or textured surfaces (shells). BIA-ALCL develops more frequently in people with textured implants than in those with smooth-surfaced implants. Like other lymphomas, BIA-ALCL is a cancer of the immune system and not of breast tissue.

Some women with implants may have experienced health problems such as connective tissue diseases (such as lupus and rheumatoid arthritis), trouble breastfeeding, or reproductive problems. There is currently insufficient evidence to support an association between breast implants and those diagnoses.

Additionally, some women have also reported health problems, such as fatigue, memory loss, rash, “brain fog,” and joint pain. Some patients use the term “breast implant illness” to describe these health problems, and some patients report that their symptoms have improved when the implants were removed. The symptoms and what causes them are poorly understood, and there is currently insufficient evidence to support an association between breast implants and symptoms referred to as BII. But researchers are investigating these symptoms to better understand their origins.

In general, follow your surgeon’s instructions on how to monitor your breast implants.

If you notice any unusual signs or symptoms, report them promptly to your surgeon or health care provider. Health care providers and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program (Click here for the report form). Complete and submit the report online. You may also call l 1-800-332-1088 to request a reporting form, then complete and return to the address on the form, or fax to 1-800-FDA-0178.

Also, follow your health care provider’s instructions for how to monitor your breast implants and for routine mammography screening for breast cancer. When you make your appointment, inform the mammography facility that you have breast implants, so enough time is scheduled for your mammogram.

Your surgeon or health care provider may also recommend other tests, such as ultrasound or magnetic resonance imaging (MRI). The FDA recommends that people with silicone implants get regular screenings to detect silent ruptures.

If you have specific questions about breast implants, ask your surgeon or health care provider.

For more information on consumer issues and health, click here to visit the agency’s  site.

While their first inclination may be to seek help from the artist who gave them their tattoo, it may be necessary to see a board-certified dermatologist for the proper diagnosis and treatment of skin problems, according to the American Academy of Dermatology.

Some common tattoo complications include infections, allergic reactions and worsening of an existing skin condition such as psoriasis or eczema, says Marie Leger, MD, PhD, FAAD, a board-certified dermatologist in New York. Sarcoidosis, an autoimmune disease that can affect the skin and other organs, sometimes first appears with bumps at the site of a tattoo, she says.

Infections are more common within the first couple of days or weeks of getting a tattoo, and they can cause redness and pain around the site of the tattoo (not just on the actual ink), drainage, crusting and pus. “If you experience these symptoms after getting a tattoo, see a doctor right away, because infections can be quite serious,” Leger says.

It’s possible for ink to become contaminated if tattoo artists mix colors or dilute with non-sterile water.

Allergies and sarcoidosis may pop up later — months to years after getting a tattooLeger says. Signs of these conditions may include itching, bumps, scaling, periodic swelling or the tattoo becoming raised, she says. Anyone experiencing these symptoms should visit a board-certified dermatologist, rather than a tattoo artist.

“Dermatologists and tattoo artists have different categories of things that they’re good with,” Leger explains. “Artists can assess cosmetic issues like ink migrating from the tattooed area to the surrounding area, and they’re used to seeing normal tattoo healing, so they can be a useful source of information about that. Dermatologists can really help manage things like infections or chronic reactions that pop up a little later.”

Leger recommends that those experiencing complications notify their tattoo artist in addition to visiting a dermatologist. “It is important for artists to know if particular patients are having complications so they can be a part of assessing what’s going on,” she says.

According to Leger, tattoo infections can come from contaminated ink, unsterile application or improper care after the tattoo is applied. In 2012, for example, an outbreak of tattoo infections in New York was traced back to a rare bacteria found in certain gray ink, which was then recalled. “It can be tough, because some of these things that can go wrong are in the control of artists and clients, and some aren’t,” Leger says.

Opened ink bottles can have more infection-causing bacteria than new bottles, she says, and it’s possible for ink to become contaminated when artists mix colors or dilute with non-sterile water, which includes distilled water. She says it’s important choose a reputable tattoo artist and diligently follow his or her care instructions.

Leger recommends that those with chronic skin conditions or a history of skin cancer talk to a board-certified dermatologist before getting a tattoo. People with psoriasis should be aware that they may develop a patch of the condition on their tattoo, she says, and those with moles should avoid tattooing over them. “There’s no strong data that shows tattoos increase your risk of skin cancer,” she says, “but they can make detection harder.”

Nearly 40 percent of people born after 1980 have tattoos, Dr. Leger says, so it’s important for dermatologists to be aware of potential tattoo issues and for tattoo artists to be aware of potential skin issues. To that end, she gives lectures and teaches classes for tattoo artists about skin cancer detection and preexisting skin conditions, and she also encourages her fellow dermatologists to make sure they examine patients’ tattoos and look for any medical problems that may appear there.

For more information on skin issues, click here to visit the American Academy of Dermatology’s website.

We don’t see a lot of patients  who are bringing in photos of celebrities and saying they want to look like them. Most of our patients now just want to be a better version of themselves. They’re taking advantage of the many low-cost, minimally invasive procedures that have been introduced in the last few years.

Minimally invasive procedures usually have less pain, a shorter hospital stay (or no hospital stay at all) and fewer potential complications. Other advantages include the low cost and little or no downtime. And many patients like the fact that there’s less of a chance their friends will notice a dramatic change in appearance.

Minimally invasive procedures usually have less pain and fewer potential complications.

Here are some examples of the new trends; I expect them to become even more popular in 2019.

Injectables. The accessibility of injectables means there is less downtime for a procedure, lower cost and less invasiveness. Injectables, lasers, and skin resurfacing can be relatively quick procedures, often with immediately visible effects.

More cosmetic treatments by men. There has been a slow but steady increase in the number of men seeking a cosmetic procedure as that becomes more mainstream. The total number of cosmetic surgical procedures performed among men was 1.2 million in 2015 — more than triple the number of men in 1997.

Exaggerated cosmetic procedures will decline. Patients increasingly want to maintain their general face structure and inherited family traits, but with a few refined tweaks.

There will be less medical tourism. What was once an emerging trend of people going to foreign countries for cheaper cosmetic procedures will continue to decline.  Horror stories of complications with no way to remedy them have resulted in many patients realizing that the cost savings are simply not worth gambling with their appearance.

The non-surgical facelift. This procedure delivers focused ultrasound energy deep into the skin, which causes it to lift and tighten and promote maximum collagen rejuvenation. Collagen is what keeps the skin looking plump, but it decreases with age. Studies show that collagen production continues to increase in the six to 12 weeks after the procedure, resulting in a tighter, more contoured look that can last for more than a year.

Dr. Jerome Potozkin, author of the new book Botox and Beyond: Your Guide to Safe, Nonsurgical, Cosmetic Procedures, is a leading dermatologist who practices in Danville, CA. For more information on his work, click here.