A few years ago a female patient came into my office for a consultation. She had gone to our website, set up the consultation and came in alone. None of this is too unusual except that this patient was only 17. As other parents of teenage girls will attest, rarely does a teenage girl do anything by herself, and ordinarily "the more, the merrier" approach applies. This young woman was anything but merry or ordinary, but she had a tremendous impact on my entire staff.

Early during the consultation she mentioned she was here to see about breast augmentation, which isn't completely unheard of for a 17 year old, but again, usually in a breast augmentation consultation for a teenager, there's more than one teenager in the room, and usually a parent as well. This solitary young woman listened intently as we discussed the procedure in general terms. After the first part of the consultation, I left the exam room so the patient could change out of street clothes into a robe for a physical exam.

As I returned to the room for the exam and initially saw her breasts, I began to understand a bit more about her situation. She explained she didn't want to be "big", but asked if there wasn't there something we could do? I asked her if she knew the term "tuberous breasts", but she didn't. This wasn't just a teenager with body image issues; she had tuberous breasts. I explained to her that she had a medical condition in which during the early growth of the breast, the tissue is restricted leading to unusually small, drooping and uneven breasts. In most cases, tissues inside the breast push against the areola causing it to bulge and enlarge. If not diagnosed properly and a surgeon tries to correct the problem by placing an implant in the tubular breast, the breast sags even more dramatically leaving the patient completely devastated. While an implant is used to correct the size and shape of tuberous breasts, it is not a traditional breast augmentation procedure. The procedure done is part augmentation, part mastopexy (breast lift) and part reduction which when done by an experienced, board certified plastic surgeon, results in a much more normal looking breast.

The tuberous breast condition is a congenital abnormality that presents with breasts that have very little breast tissue, and whatever tissue there is, is unusually dense. Because of the abnormal breast tissue, breast-feeding is often compromised. The areola is large and puffy looking, and the chest wall is very narrow but there's a wide gap between the breasts. There's no known specific cause for this condition that affects about 1% of the population, including a few males. The unusual shape the breasts take can result in unflattering terms like "torpedo t*ts" or "Snoopy breasts" which can be especially damaging as the condition appears in adolescence.

While explaining the tuberous breast condition to this young woman, her entire demeanor changed. She was clearly relieved to find out that there actually was something wrong. I asked her if she had told her parents about coming to see me, and she had not. She had done all the research and consultation scheduling on her own. I explained that her condition was absolutely treatable, but to do so she would need her parents' consent. The next day she and her Mother came in to see me. Mom cried. Daughter cried. Although the daughter had told her Mother that she thought there was something wrong with her breasts, her Mom understandably perhaps, thought she would out grow it. Knowing the struggles, insecurities and embarrassment her daughter had suffered without her support was now breaking the mother's heart, and she was just beginning the process of dealing with some guilt because she didn't listen to her daughter. "I just didn't know. I never saw her breasts, and I assumed she was just being impatient because her friends all developed before she did."

We doctors are privy to some pretty personal stuff in our patients' lives. Working through this medical issue, first with the daughter and then with the mother gave my entire staff a peek into their family. While the mother felt like she had failed the daughter, she did the best thing she could do at that point. That night when they returned home after the second consultation, they sat down and shared the story with "Dad". Three weeks later when the patient came in for surgery, much of her extended family came with her for support. By this time the tears had dried. The family had done a great deal of research on tuberous breasts and had some insightful questions for me when I came to give them the report after surgery. The mood was definitely one of support and love.

The patient made a quick, routine recovery and is a much more confident and comfortable 20-something college graduate now. Her courage and strength touched all of us, as did her family's resilience and tenacity. Tuberous breasts had impacted this young woman's life, but she had the courage to not let it negatively impact her future.

By now we've all learned in varying degrees that some of what we read online isn't exactly "fact". Now there's absolutely nothing wrong with people posting or blogging using opinions or even writing and sharing fictional stories online - as long as it's clear to the readers that what they're reading isn't "fact".

One of the most effective ways for doctors to get new patients is through word of mouth advertising and in this age of computers and the internet, that translates into posters going onto various websites with comments and stories about the wonderful experience they had with their doctor or the remarkable results they got from a certain cosmetic procedure. The good news here is that this could be one of your best tools when researching a specific treatment or when looking for a plastic surgeon, as these personal reviews tend to carry a great deal of veracity with them. The bad news is that some companies are attempting to generate business by duping consumers.

In 2009, New York Attorney General Andrew Cuomo settled a claim resulting in a $300,000 settlement against a company doing just that by using "...cynical, manipulative and illegal" methods. Lifestyle Lift was the first company to be penalized for using these "Astroturf marketing" techniques, so named because their aim is to create bogus grassroots buzz about a product. The company admitted it required employees to pose as satisfied customers in their online ads. As if that wasn't bad enough, they also went so far as to create websites to highlight these reviews as legitimate, unsolicited testimonials. In a company e-mail, Lifestyle Lift instructed employees to "...devote the day to doing more postings on the Web as satisfied clients..." and in doing so violated consumer protection laws.

So how do you as a consumer know which reviews, which patient/client comments to believe? That's a great question, and I wish there was an easy answer to it. There is no magic bullet here. Don't rely solely on patient comments, but don't discard them either. Rely on as many tools as there are available, with patient reviews being just one of those. Some of the other things to look for:

MUST BE a board certified plastic surgeon
"CV" or "curriculum vitae" which is their professional resume - where/what did they study?
active in the profession in a teaching and learning capacity
review their personal before and after pictures
consult with more than one surgeon

When all of the items are compared, then you have to rely on what you feel. If you're comfortable with what you're experiencing when at the doctor's practice, you've probably found the best doctor for your care. As simple as that sounds, IF everything else is equal, trust your gut!

Repair CO2 Fraxel

A little over a year ago we did a press release on "Repair CO2 Fraxel". Since it's appearance on the plastic surgery horizon, it has become one of the most utilized additions to a large number of our facial surgery/rejuvenation cases. As an active professor at UTSW Medical School here in Dallas, I see any number of "new", "improved" and sometimes "re-cycled" surgical procedures with various claims of success. With over 25 years of cosmetic surgery experience, there have been some truly revolutionary treatments, approaches and products introduced during my career. Repair Fraxel is one of the products that has met expectations.

Repair Fraxel is a one-time treatment requiring general anesthesia which is done on the same floor as my office at the Dallas Day Surgery Center. The recovery period is five to seven days at home before resuming normal daily activities. Post-op patients usually experience a severe sunburn appearance, which heals and fades into a smoother, and regenerated skin surface. When done in conjunction with a facelift procedure, the Fraxel Laser magnifies the resultant skin rejuvenation by addressing the fine lines, wrinkles and skin discoloration that are not intended to be the primary focus of most face lift procedures. Men who have spent years in the sun playing golf, and basketball, or fishing and hunting may have extremely damaged skin. Fraxel has proven to be very effective in restoring a more youthful complexion.

Zeltiq

Zeltiq is a new non-invasive, no downtime procedure which targets and then eliminates fat cells. Currently, it is being used on the abdomen, flank and back, with anticipated expanded usage in the future. Zeltiq has some of the same results as liposuction without requiring anesthesia of any kind and no downtime. After the roughly one hour treatment, patients can immediately return to work, home or the gym with no side effects. The full results are apparent in two to four months as the size and number of fat cells dissipate.

Zeltiq has many advantages for men looking to lose some extra belly fat that may have creeped up on them silently over the course of years, or the love handles that may be the result of some recent holiday over-indulging. The first step is a consultation to determine if you're an appropriate candidate for Zeltiq. If you qualify, you will be taken to the the fifth floor of our building to the EpiCentre Skin Care and Laser Center. You'll then set up an appointment to come in for an hour treatment, and that's it. There are no post-procedure pain medications, no downtime, no scarring, and when the procedure is done, you're ready to resume the rest of your day.

The most important thing for men to know is that there are options available to them that range from these two new, innovative procedures, to the established liposuction and facelift procedures, and the other procedures we've discussed as part of this series. If you're not happy with your appearance, make an appointment for a consultation and get the information you need. An e-mail or phone call is all that's necessary to start the process and get a consultation appointment. Take the time, make the call, and then look at your options - we'll be happy to help you in anyway we can.