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Building the perfect body
Top 10 most popular procedures


March 2014

Although nobodyís perfect, a growing number of us seem to be searching for a way to achieve perfection, judging by the increasing demand for cosmetic procedures. In fact, the total number of surgical and nonsurgical cosmetic procedures performed in the United States by plastic surgeons has nearly doubled since 2000. Hereís a glimpse at what is popular in the greater Milwaukee area.

Tummy Tuck: The tummy tuck or abdominoplasty is among the top surgeries being performed by Dr. Philip L. Sonderman of Greater Milwaukee Plastic Surgeons in Brookfield. "This is a procedure that flattens the abdomen by removing extra fat and skin and tightening the muscles in the abdominal wall. It can now be done as an outpatient procedure with the use of a new long-acting local anesthetic, which cuts recovery time way down," Sonderman explains.

Breast Augmentation: Along with the tummy tuck, breast augmentation is in high demand, Sonderman says. "This is especially true now that there is a much improved silicone gel implant that holds its shape and is more natural looking and natural feeling," he says. "Not only that, but the implants have a much lower chance of capsular contracture or leakage, which was the problem in the past."

Body Contouring: Liposuction, which surgically removes fat cells from the body, has been around for some time. Now, nonsurgical fat reduction using ultrasound and radio frequency is quickly taking over. "This nonsurgical, noninvasive body contouring and skin-tightening treatment melts fat cells so the body reabsorbs them," says Dr. Andrew Campbell of Quintessa Medical Spa in Mequon. "A patient usually has several treatments over a period of weeks, but unlike liposuction, there are minimal restrictions after these treatments."

Blepharoplasty (eyelid surgery): "Blepharoplasty, otherwise known as a Ďlid-lift,í of the upper and sometimes lower eyelids is the most commonly performed eyelid surgery," says Dr. Bruce M. Massaro, a board-certified ophthalmic plastic surgeon. "Cosmetic eyelid surgeries reshape the lids, correct sagging, bagging and drooping eyelid tissues that make people look tired and older. Surgeries involve the removal, support, contouring and redirection of these delicate tissues to create a natural, rested, more youthful appearance," he says, noting that the eyelid incisions can easily be hidden in the natural lid lines.

Forehead/Brow Lift: "Some patients with heavy-looking eyelids who undergo blepharoplasty also may require eyebrow or forehead lifting because the upper face tends to slide downward with age, affecting the look of the eyes," Massaro says. "The forehead/brow lift most often involves incisions hidden behind the hairline of the scalp."

Ptosis Repair: Additionally, some patients with "heavy eyelids" also require repair of the internal eyelid lifting muscle known as ptosis repair, which is done along with the blepharoplasty. Massaro notes that the number of blepharoplasty surgeries he has performed has increased during the last decade. "Typical patients are in their 40s and 50s, and while women outnumber men, the number of men seeking surgery continues to increase," he says.

Laser Skin Resurfacing: "We are doing an increasing number of laser treatments," Campbell says. "The treatments are tailored to the patient and we often use a combination of lasers to treat dark spots, improve the texture and surface irregularities of the skin, and erase lines and creases, for example. It is highly customized and extremely effective," he adds.

Mini Face-Lift: A mini face-lift can remove years from your face and improve your outlook ó in just one afternoon. "The mini lift is not as invasive or costly as a full face-lift, but it can be very effective," Sonderman says, noting that younger patients in their 40s are requesting these procedures. "The mini lift provides many of the same benefits of a full face-lift, but shorter incisions are made; therefore thereís less scarring and a quicker recovery," he says.

Injectable Fillers: Botox and other injectable fillers are in demand because of their ability to improve and relax frown lines and reduce facial wrinkles and imperfections. "Voluma, a brand new filler, has been approved by the FDA and specifically designed to restore volume to the midface. This filler has a much longer life, lasting up to two years," Campbell says, stressing that it is important for the person performing the procedure to understand the facial anatomy to get the best results.

Rhinoplasty: Commonly called a "nose job," rhinoplasty can reshape the nose and is one of the most common of all plastic surgery procedures. "It can reduce or increase the size of the nose, change the shape of the tip or the bridge, narrow the span of the nostrils, or change the angle," according to Sonderman. It also may be done to correct a birth defect or injury. "It is important to have realistic expectations about this surgery and all plastic surgery and procedures," he adds.

What is the Shelf life of your cosmetic procedure?

Cosmetic procedures like Botox injections, fillers and face-lifts are aesthetic investments patients contemplate well in advance of stepping into a doctorís office. But they often require more than a one-time visit, so itís important to know how long a procedure is expected to last and what the signs are that itís time to refresh or renew it.

Age, severity of problem areas and genetics all factor in to figuring out that time table. Yet, there are some general rules of thumb.

Dr. Alex P. Colque at Skiin Anti-Aging Lounge in Waukesha says Botox injections typically need to be redone every few months, while hyaluronic acid-based fillers such as Juvederm last nine months to a year. Thicker fillers, made from calcium hydroxylapatite, can last up to 18 months. "Botox has been out for 10 years," Colque explains. "There are certain techniques that we use to make it work better and more effective, but the medication is still the same."

He and other experts say itís best to be proactive rather than reactive. Although a small percentage of patients return before needing their next treatment, many wait until wrinkles reappear or lifts begin to fade. But waiting can exacerbate the issue. "If they donít keep up (regular treatments), itís more difficult to make wrinkles disappear," he insists.

Plastic and reconstructive surgeon Mark F. Blake of the Clinic of Cosmetic Surgery in Milwaukee says education is key. He advises patients to do their homework.

"Concentrate on the issue youíre trying to address, and make sure that the treatment is doing what you need," says Blake, who is also medical director of LíImage Skin Spas.

For instance, there are various face-lift treatments, including mini lifts and skin-only face-lifts, that Blake says do not always live up to their claims. Itís the muscle-tightening face-lift, he says, that is most widely used by plastic surgeons and that has the most effective result over a longer period of time.

Plus, he says other considerations impact efficacy: Is the patient over 50? Was there sun damage, severe sagging or deep creases before? Blake says such factors can contribute to how far a treatment can "set back the clock."

"People really need to be educated," he adds. "Go somewhere where they have all of the tools, so that youíll have all of the options available. Thatís the most important thing."

- Lisa Jones Townsel

Aesthetic nurse specialists now sanctioned

The expanding field of aesthetic nursing now has its own nationally recognized exam and certification. Not to be confused with plastic surgery certification, the aesthetic nurse specialty focuses on the use of cosmetic treatments such as dermal fillers like Botox, chemical peels, microdermabrasion and laser treatments, rather than surgery.

Locally, Dawn Sagrillo of ReFresh Aesthetic Center in Whitefish Bay was instrumental in the development of the first and only national exam and certification for aesthetic nurse specialists. Sagrillo, the clinical director and aesthetic nurse specialist at ReFresh, worked on creating the exam for five years, along with three of her colleagues. "We worked collaboratively with the American Society of Plastic Surgeons to obtain their support and approval. We wanted to include any nonsurgical cosmetic treatment as well as the psycho-social aspects of the treatments," she explains.

What does this mean to potential patients? "Patients benefit because this is a growing specialty with many providers offering injectables and various other treatments, and it can be confusing. We felt that certification tells the public that these nurses have met certain core competencies that create a standard of care that ensures safety to the patient," Sagrillo says.

Not just anyone can take the CANS exam, which is another way to demonstrate the dedication of those nurses who earn the certification. "Nurses have to meet the criteria. They have to be in the field for two years before they are eligible to take the exam. They must spend 50 percent of their time doing this work, and they must maintain it to keep the certification," Sagrillo says. "Itís an exciting time for this specialty."

For more information about where the CANS exam can be taken, go to

- Joann Petaschick


This story ran in the March 2014 issue of: