All posts by mbadmin

Breast augmentation: what you as a patient need to know


  1. How do I know if breast augmentation is a good option for me?
    1. Breast augmentation is the second most common cosmetic surgery after liposuction. Those who would benefit the most are those who desire an increase in breast size, or to restore breast shape after postpartum deflation. Other common reasons are to correct breast asymmetry, enhance breast shape and volume, and improve fitting in clothing.


  1. Are there any reasons why I would not qualify for breast augmentation?
    1. You must be nicotine free for 4 weeks before and after surgery. Patients requiring anticoagulation are generally not candidates.
    2. You must be older than 18 years for breast augmentation and older than 22 years for use of silicone implants
  1. What’s better, silicone or saline? Also, my friend has “gummy bear” implants, should I get those?
    1. The advantage of silicone implants are they feel more natural and look more natural than saline. Saline implants can wrinkle and thus look and feel less natural. On the other hand, ruptured silicone implants can be difficult to detect and can cause local inflammation resulting in granulomas. Therefore, the FDA recommends MRI 3 years after surgery and every 2 years thereafter for silicone implants to monitor for undetected leaks or ruptures. If a saline implant leaks or ruptures, the saline is safely absorbed by the body.


    1. Gummy bear implants, also known as shaped or textured implants, were designed to decrease the rate of capsular contracture associated with breast implants. There is evidence that links these implants in rare case to a lymphoma known as anaplastic large cell lymphoma (ALCL). Recent hearings by the FDA confirmed these findings. Due to the low but present risk of associated lymphoma, it is our practice’s policy not to use textured implants.
  1. How do I know what sized implants to choose?
    1. Implant size is based upon the patient’s goals in terms of desired breast size and projection. The implant size is limited by the measured patient’s breast base width. These goals are discussed with a board-certified plastic surgeon who will offer what implants sizes are possible in coordination with patient safety. Choosing implants that are too large has unwanted consequences of stretching the tissues and potentially causing rippling, palpability of the implant, and atrophy of the breast skin and tissue.
  1. Where will my scar be?
    1. Generally, our practice utilizes a scar in the fold of the breast otherwise known as the inframammary crease. This allows for a well-hidden scar and that allows for best control of the implant placement.
    2. There are other options but they carry greater risk and limitations. The peri-areolar scar has a higher rate of infection, problematic scarring and nipple sensitivity changes. The transaxiilary scar can have a higher revision rate due to difficulty in proper placement of the implants. The transumbilical scar is limited by only the use of saline implants.
  1. Will the implant be placed above or below the muscle?
    1. This question is in reference to if the implant is placed above or below the pectoralis muscle, also known as subpectoral (below the muscle) versus subglandular (above the muscle).
    2. Subpectoral is the most common method for implant placement. Its major advantage is that it has minimal interference with mammogram screenings for detection of breast cancer. Its disadvantage is in patients who have a muscular chest because flexion of the pectoralis muscle can cause visible rippling of the implant known as animation deformity.


2 – subpectoral augmentation

    1. Subglandular placement has the advantage of avoiding animation deformity. However, it does have a higher rate of capsular contracture, more implant wrinkling and palpability, and it can interfere with mammogram detection of breast cancer.

4 – animation deformity

  1. Will I need a breast lift at the same time?
    1. A breast lift is known as a mastopexy. In combination with augmentation it is known as augmentation mastopexy. Common indications for needing a lift with augmentation include postpartum atrophy of the breasts with associated ptosis, if the nipple position is below the level of the breast fold, massive weight loss patients, or if there is no visible skin below the areola when viewed in a standing position. The decision for a lift in combination with an augmentation should be made in coordination and discussion with a board-certified plastic surgeon.

3 – breast lift with implant – augmentation mastopexy

  1. What are the complications associated with this surgery?
    1. 15% of patients have altered nipple sensation
    2. Infection rate is low at < 1%, as is risk of hematoma
    3. Saline implants leak at a rate of 1% per year. Silicone leak rates incidence is difficult to assess. Some studies cite 30% at 5 years. For this reason, the FDA recommends MRI surveillance for leaks/ruptures with silicone implants. If found, a discussion with a board-certified plastic surgeon is necessary to discuss removing the implants and possibly the capsule, and replacing the implants.
    4. There is the possibility of need for reoperation or revision – 20% rate over 3 years. The most common reason for revision is size change.
    5. The long-term risk associated with implants is the phenomenon known as capsular contracture. This is where the human body forms a capsule around any foreign object present within soft tissue. Over many years the capsule formed can become hard and even calcified. In some cases, the firm capsule can result in pain or distortion of the breast. In those cases, removal of the implant and capsule is needed along with replacement of the implant.

1 – left breast capsular contracture

  1. After surgery, when can I start exercising again and when can I return to work?
    1. Ok to commence aerobic activity and exercise at 2 weeks. Ok to start exercising with weights at 6 weeks. Until then, no lifting more than 5 lbs.
    2. Ok to return work after 3 days. Ok to drive 24 hours after surgery
  1. Any other limitations?
    1. No underwire bra for 6 weeks, wireless bras only
  1. How can I learn more and schedule a consultation?
    1. Call (205) 871-4440 to schedule a consultation with one of our board-certified plastic surgeons to discuss more regarding breast augmentation. Our office is located at 2850 Cahaba Road, Birmingham, Alabama 35223


  1. Schwartz, Michael. “Evidence-Based Medicine: Breast Augmentation.”  Plastic and Reconstructive Surgery Journal. CME. July 2017.
  2. Hidalgo, David; Spector, Jason. “Breast Augmentation.” Plastic and Reconstructive Surgery Journal. CME. April 2014.
  3. Hidalgo, David; Spector, Jason. “Mastopexy.” Plastic and Reconstructive Surgery Journal. CME. October 2013.

4. Hammond, Dennis C; Schmitt, William P.; O’Connor, Elizabeth A. “Treatment of Breast Animation Deformity in Implant-Based Reconstruction with Pocket Change to Subcutaneous Position.” Plastic and Reconstructive Surgery Journal. Vol. 135, Number 6, June 2015.

Brachioplasty and improvement in the upper arms

I am often asked by patients, “Dr. I really want to wear sleeveless shirts in the spring and summer, but I am bothered by the appearance of my upper arms. Is there anything that can be done?”

The answer is “yes,” there are surgical options for aesthetic improvement in the upper arms. Those options depend on the amount skin laxity and excess fat in each patient.

Excess fat within the upper arm requires liposuction to remove the fat. Laxity of the skin requires an incision and a potential scar to remove or excise the excess skin. The scar placement and length of the scar depends on the location and amount of lax skin. If both excess skin and fat are present, liposuction and excision of skin are needed. Let’s look at some examples.

The picture above shows moderate skin laxity in the first third of the arm with minimal excess fat. This patient would be a good candidate for excision of the excess skin with a limited scar in the shape of a T placed within the “armpit” or axillae. This scar is represented in red in the picture below.

The next example above represents a patient with both moderate skin laxity and moderate fat. This patient would be a candidate for liposuction and a traditional brachioplasty, in which the scar is placed in the brachial groove as pictured below.

Last, the above picture represents a patient with severe skin laxity that extends on the chest. This is typical in patients who have experienced massive weight loss due to bariatric surgery. These patients require an extended brachioplasty in which the scar runs along the brachial groove as in a traditional brachioplasty, but also is extended onto the chest wall as shown below.

The following are questions and answers one should know if considering brachioplasty:

1. Who is not a candidate for brachioplasty?

Patients with neurological or vascular disorders of the upper extremity, lymphedema of the arms and collagen vascular disorders such as Ehlers-Danlos are not candidates. In addition, patients with severe medical conditions such as heart disease or uncontrolled diabetes are poor candidates.  Your weight should be stable for 6 months to 1 year prior to surgery and it is preferred that you have are not expecting any additional pregnancies. You must be nicotine free for at least 1 month prior to surgery. Patients with a history of keloids or hypertrophic scars are also poor candidates.7

2. What is the most common complication of brachioplasty?

The brachioplasty scar is likely the most noticeable scar in all of aesthetic surgery. The procedure trades a more pleasing shape and contour of the arm for a scar. The scar is not inconsequential and will be visible depending on the type of clothing. The scar may stay thick and heavy for a prolonged period of time. The final appearance of the scar will not be visible until 1 year post surgery. Surveys of plastic surgeons and the general public showed that a scar in the inner arm is preferred to a scar in the back of the arm. The scar in the inner arm is less visible – only seen when the arm is externally rotated – however, the skin is thinner here and thus the scar may become wider. The scar on the back of the arm can be thinner because of better skin quality, however it is more visible from behind when wearing sleeveless clothing.8

Other potential complications include wound dehiscence, seroma, infection, numbness, recurrent skin laxity.

3. What can I expect after surgery?

A drain is in place for less than a week. The arms are wrapped for 2 days and then removed by your surgeon. Then for 2 weeks, patients are encouraged to wear snug clothing such as “Under Armor” long sleeve shirts for compression. No raising arms above shoulders for 2 weeks, afterwards gentle range of motion exercises can start.

4. How much does it cost?

For a consultation and to discuss options call Mountain Brook plastic surgery at 205 871 4440.


1-6 Miotto G, Ortiz-Pomales Y. Arm Contouring: Review and Current Concepts. Aesthetic Surgery Journal. 2018, Vol 38(8) 850-860.

7-8 Angelos, TM, Janis JE, Mendietta, CG. Brachioplasty. Essentials of Aesthetic Surgery. Chapter 58, 818-827. Thieme Publishers, New York, 2018.

All you need to know about Fillers

  1. What is a filler and how is it used?

Fillers are injectable products that are injected to rejuvenate and improve facial features associated with aging. This includes filling of rhytids, otherwise known as “wrinkles.” The wrinkle areas most commonly improved by filler injections include:

Nasolabial fold

Marionette lines

Fine lines of the upper and lower lips or “smokers” lines

Tear trough deformity

Fillers are also used to provide volume and augment areas prone to facial aging. This includes the upper and lower lips and the cheek.

  1. What are fillers made of?

There are numerous filler products and each is made of different material. The most common material used currently is hyaluronic acid, this is the composition of Restylane, Perlane, Juvaderm and Belotero.

Others such as Radiesse are made of calcium hyodroxylapatite. Sculptra is made of poly-L-lactic acid.

  1. How do you know which filler or which material to inject?

Different fillers work best for different areas. Hyaluronic acid fillers such as juvaderm tend to absorb more water and therefore are great for areas such as the nasolabial folds, lips, and marionette lines. Sculptra works well for facial augmentation of the cheeks or temples. Belotero works well for fine wrinkles.

  1. How long do they last?

Hyaluronic acid fillers and Radiesse can last up to 1 year. Sculptra can last up to 2 years but requires more than injection.

  1. Is injection painful?

Your surgeon will typically apply a lidocaine topical cream that will need to sit for 30 minutes prior to injection. Typically, this allows for minimal discomfort during injection.

  1. What are my limitations after injection?

Most surgeons recommend no exercise the day of the injection. The day after there are no restrictions.

  1. Are there any complications to be aware of?

Although not a complication, the most common complaint is under-correction. Over-correction can also occur, so discuss in detail with your surgeon your goals and expectations prior to injecting.

The injected material may be palpable or bumpy and cause nodules. This can usually be corrected with massage.

Although rare and infrequent, serious complications can occur. If filler material is injected into a blood vessel, this can result in skin necrosis – this is more common around the nostrils of the nose. Board certified plastic surgeons are well aware of this risk and are trained with techniques to avoid this complication.

Another rare and infrequent but serious potential complication is blindness. This occurs with injection of filler material around the eyes. Again, board certified plastic surgeons are well aware of this risk and are trained with techniques to avoid this complication.

  1. How do I learn more and how much does it cost?

Call Mountain Brook Plastic Surgery for consultation with board certified plastic surgeons!


What is botox?
Botox is a drug made from a toxin produced by the bacteria Clostridium botulinum.

How does it work?
Acetylcholine is released from nerve endings and causes muscles to contract. Botox binds to nerve endings preventing the release of acetylcholine and therefore preventing muscle contraction.

How is it used?
Botox is used to treat numerous medical problems. It is most commonly known for treatment of facial wrinkles and, in fact, is the most common cosmetic procedure in the world. It also can be used to treat parotid gland hypertrophy, profuse sweating of the underarms, hand and feet, and for the treatment of migraines.

For facial wrinkles, where is it commonly used?
Common areas for injection for improvement of facial wrinkles include the frown lines of the glabella (vertical lines between the brows), forehead wrinkles, smile lines, crow’s feet, bunny lines, elevating the corners of the mouth, dimpled chin, and for the platysmal bands of the neck.

Does the injection hurt?
A very fine needle is used to induce the least amount of discomfort. Some patients prefer a lidocaine cream applied to the area to be injected to temporarily numb the skin. Some patients tolerate the injection with little discomfort without the lidocaine cream.

How long does it take the botox to take effect?
Results are typically apparent after 2-3 days.

How long does botox last?
Each patient is different in terms of response, the average length of time of effectiveness is 3-4 months.

Are there any side effects and any limitations after injection?

  • Some patients may experience a headache following injection. This typically subsides without treatment.
  • Occasionally injections are not symmetric which may result in asymmetry. These asymmetries may be remedied with a small “touch up” injection.
  • Overtreatment of the forehead may result in a drooping brow. After the botox “wears off,” the brow position will return to normal.
  • Upper eyelid droop may occur if injections on the brow are too low. This can be treated with eye drops prescribed by your physician that counteract the effects of botox.
  • Limitations following treatment will vary from physician to physician. Some recommend no exercise the day of injection, others recommend no lying down for 4 hours after treatment, and some do not restrict their patients.

How can I learn more?
Call Mountain Brook Plastic Surgery (205) 871-4440 for consultation!

What is a tummy tuck? – Dr. Brad Denney

A “tummy tuck” is a cosmetic surgery that involves rejuvenation of the abdomen and flanks. Your plastic surgeon may also refer to this procedure as an abdominoplasty. There are three major components of a tummy tuck – management of excess skin, contouring of excess fat, and tightening of the abdominal muscles.

Multiple terms are used to describe tummy tucks, such as “mini” or “full” abdominoplasty. This refers to the degree of excess skin and fat that exists, and therefore the length of the incision needed to accomplish abdominal rejuvenation. If there is a small amount of excess skin and fat below the belly button, a “mini” abdominoplasty may be performed. The incision is made in the middle third of the abdomen along the bikini line. A “full” abdominoplasty, on the other hand, deals with moderate to larger amounts of excess skin and fat above and below the umbilicus, and therefore requires a longer incision, typically the entire length of the bikini line and around the belly button itself.

Patients who typically benefit from a tummy tuck include those who want improvement in their abdominal contour and waistline and want to fit better in clothing. Patients typically notice changes in their abdominal contour after pregnancy that cannot be improved with exercise alone. This is usually due to rectus diastasis, or widening of the abdominal muscles, due to the pressure on the abdominal wall in pregnancy.

The surgery itself takes about 3 hours and most patients are able to go home the same day. Most surgeons will leave a drain under the skin that will be removed by your surgeon after a few days. Many patients will feel the need to walk “hunched” over for a few days due to the tightening of the abdomen. Liposuction is often utilized as part of the tummy tuck procedure, especially along the flanks. It is expected to have bruising and swelling in the areas of liposuction for several weeks after surgery. Typically, a tummy tuck scar is hidden in the bikini line. Most surgical incisions will fully heal in 6-8 weeks.

The most serious possible complication to be aware of with this procedure is a DVT, or a blood clot in the legs, or rarely a PTE (blood clot in the lungs). In the lungs, blood clots can potentially be fatal. Therefore, all surgeons will stress early post-operative ambulation to prevent the development of blood clots.

For more information and to schedule a consultation, please call our office at (205) 871-4440.