Web Chat on Plastic Surgery with Dr. Robert D. Wallace, M.D., Department of Surgery, UT Medical Group, Inc. (The following is an edited transcript of questions and answers from a web chat held on Wednesday, January 9, 2002 on News Channel 3)

Moderator: Hi and thanks for joining us today. Dr. Robert D. Wallace, UT Medical Group Plastic Surgery is here and ready to take your questions on anything dealing with cosmetic surgery.

Q: What is the most common procedure you do?

Dr. Wallace: The most common procedure done through our office is breast augmentation, followed by liposuction, blepharoplasty (eyelid surgery), and rhinoplasty (nose contouring).

Q: I need to have something done to my eyes. Can you do an image where I can see what it will look like before I do it? And are there any guarantees?

Dr. Wallace: There are image machines that can help you get an idea of the post-operative result. Most offices in the Mid-South do not have this machine. We do not have it in our office because it can imply a guarantee of what you would look like. There is no guarantee. That's why you have to select your surgeon carefully.

It is very important to check your plastic surgeon's qualifications before you have a procedure performed. It's also important to know that they have privileges to practice at a hospital rather than just an surgery center or office. Look for board-certification in a specialty that trains in cosmetic surgery procedures.

Q: What different types of breast surgery are there? I want to look into it, and see about how much it costs.

Dr. Wallace: Most women are candidates for breast augmentation (enlargement). As women get older and their breasts start to fall, breast lifting procedures become more common. Costs vary among surgeons depending on their experience and skill. If you'd like more details, you can call my nurse, Tracey Snider at 901-347-8290, and she will be happy to help you further.

Other forms of breast surgery are reduction (mammoplasty) and breast reconstruction. These procedures are covered by insurance and patients who have these surgeries often have very high satisfaction.

Q: Is it safe? And would the surgery be permanent. I mean I wouldn't have to come back with problems.

Dr. Wallace: Implants can be removed if you're unhappy with them. This is real surgery, and with real surgery comes potential complications. That's why a consultation is important to find out all the information.

Dr. Wallace: A good resource is the web site of the American Society of Plastic Surgeons (ASPS) www.plasticsurgery.org.

Q: I had a belly piercing get infected, and now it looks terrible. What can I do?

Dr. Wallace: It's possible that you could have a scar revision which would minimize the appearance of the scar. But you will always have a scar.

Q: How does one finance a gastric bypass since the insurance does not pay?

Dr. Wallace: I'm sorry but plastic surgeons do not do gastric bypass surgery.

Q: I just had a baby and am interested in liposuction, should I wait until I lose some weight to get the best results?

Dr. Wallace: It's probably best that you wait 6 months before you consider liposuction after delivery. Don't be frustrated if you don't get back to your pre-pregnancy weight as that is very common. It doesn't mean that you're not a candidate for liposuction. It's important that you get to a weight that's stable and one you can maintain. When that occurs, I suggest that you seek consultation.

Q: Hi, about what price range is the lyposuction for the thighs and anything else you can tell me on the subject?

Dr. Wallace: Prices vary tremendously among surgeons. The cost for the surgery center and anesthesia are largely the same regardless of what surgeon does the procedure. Typically for liposuction of one area (the thighs), the total cost would range from $3,000-$3,500.

Q: I have had silicone implants for about 10 yrs, is there reason to worry about having them removed if there is no apparent problems other than being extra firm?

Dr. Wallace: I would say it sounds like the firmness relates to capsules that have formed around the implant. I would recommend that you have a consultation to obtain information about possibly exchanging your implants. We have ex-planted a number of silicone implants, and the data has shown that implants that are 10 years and older have a greater than 50% chance of having a leak. While that leak may not be a problem, it is important to make sure that the silicone does not leak into the breast tissue and cause masses that are difficult to distinguish from breast cancer without a biopsy.

Q: I have a planned breast reduction surgery in two months - what should I do in preparation for the surgery?

Dr. Wallace: Your doctor should give you all of the necessary pre-op instructions which should include medications to avoid two weeks prior to surgery and a discussion of his post-operative management.

Q: I’ve emailed you before and you have given me your nurse’s beeper number. Thanks, she was very helpful. But I am still concerned about after having my surgery (enlargement) after my implants. I am now producing milk and they tend to be swollen. Is this normal; I have not breast fed in five years?

Dr. Wallace: Feel free to contact Tracey Snider again. If you'd like, she can schedule a consultation with me.

Q: Can you give more details on the breast surgeries to help after pregnancy sag?

Dr. Wallace: There are many options available for you including augmentation and breast lifting. You can contact my nurse, Tracey, who will be happy to mail you brochures that explain the procedures. She can be reached by calling 347-8290. Or a good web page for information is www.plasticsurgery.org.

Q: I had breast surgery about seven years ago since then I have had to replace my right implant replaced 4 times because of deflation and my left one 3 times what can cause this many deflations.

Dr. Wallace: Your history is unusual and unfortunate. Possible causes for deflation include types of implants used and fill volumes of the implant. Do you know what type of implants you have?

Reply: Saline

Dr. Wallace: Do you know the manufacturer and the type of shell--smooth or textured?

Reply: Mentor - At first they were textured the first couple of times now they are smooth.

Dr. Wallace: The Mentor Company has a warranty program, so I hope you've taken advantage of this to recoup some of the cost for your repeated surgery. You meet the criteria to be included in the silicone implant study from Mentor Company. It's possible to have your smooth implants replaced with silicone implants. Call my nurse, Tracey, at 347-8290.

Q: I have a lipoma located just to the left of my tailbone. I would like to have it removed and a friend said I should have a plastic surgeon do it. Obviously, I am concerned about scarring. What is your opinion?

Dr. Wallace: If it's small, it's a relatively simple thing to do and could possibly be done in the office. It's also a procedure that's usually covered by insurance.

Q: I heard silicone implants might become an option again. Is this true, and are they more natural looking?

Dr. Wallace: That's a good question. I now use silicone implants under a study protocol if the patients meet the criteria that allows them to be included. The data has basically shown that silicone implants are safe, and the ASPS expects the FDA to allow their use for all patients within the next couple of years.

Q: Also what is the recovery time for a breast lift?

Dr. Wallace: Two weeks is reasonable for a recovery time.

Q: I have a keloid scar on my abdomen as a result of surgery (ectopic pregnancy 1989). In august I have a hysterectomy and the same area was cut and the doctor removed the old scar and gave me injections of kenalog (misspelled i know). Anyway the scar has returned. It's wide but not very raised. I'm now using ultravate 0.05% ointment but i can't see any results. Is it possible to get better results by having it removed again and starting a treatment process immediately or am I just stuck with this?

Dr. Wallace: It's hard to tell without seeing the scar and seeing if it's truly a keloid or just a hypertrophic scar. Steroid injections sometimes will help. I would suggest that you consult a plastic surgeon for more information. If you like, you can call my nurse, Tracey Snider, at 347-8290.

Q: I am a mother of two and weigh about 130 and I am 5'2 but my breast size is about 36DD is there any way i can get my insurance to pay for a reduction?

Dr. Wallace: Most likely they will pay for it. What we have to do is write a letter of predetermination including your symptoms, breast size, and photograph. Then it's usually approved, particularly when you're 36DD and only 5'2". You sound like an excellent candidate for reduction.

Q: Is there anyone in the area that does gender reassignments? Or do you recommend anyone?

Dr. Wallace: I don't know anyone in the area who does this.

Q: I had Co2 laser surgery last January and have scars on my face. What can be done for this?

Dr. Wallace: Are the scars because of the surgery or did you have the laser surgery for the acne scarring?

Reply: The scars are from the surgery...sorry...I've never had acne...they are small round whitish scaring, just the size of the laser used on me..

Dr. Wallace: It's possible with some skin care products to improve the appearance of your scars and even out the pigment. That sounds like the problem. Has your surgeon offered you any suggestions?

Reply: YES...she wants to redo the Co2 laser surgery...and I'm afraid of more damage…so I haven't agreed to it.

Dr. Wallace: I suggest that you get a second opinion to ease your mind.

Q: I have heard that a breast reduction is very painful and you will loose your sensation. Is this true?

Dr. Wallace: Neither of those things is true. Most women tell me that breast reduction is not near as uncomfortable as childbirth. The loss of nipple sensation is possible, but in skilled surgeon's hands should be less than 2%.

Q: I am interested in a breast reduction, but the surgery terrifies me. Are there any advances they are making in the area of that surgery?

Dr. Wallace: The procedure has evolved to where smaller incisions and possibly liposuction can be used. This depends on the anatomy that you have and the amount of breast tissue that needs to be removed.

Q: I am a mother of 2 and would like my old breasts back! Do you use the saline implants? Are they safer than silicone?

Dr. Wallace: Unless you also need a breast lift, you do not qualify for use of silicone implants at this time. Saline implants have a long record of safety and are the only implants available for you at this time. We do use saline implants most commonly.

Q: How common is the removal of skin tags?

Dr. Wallace: This is very common. It can be easily done in the office.

Reply: My daughter has skin tags on each ear would she have to be sedated for this? Is it safe to remove skin tags on a 3 month old?

Dr. Wallace: Yes, usually children are sedated in a hospital operating room or surgery center. It is safe to remove skin tags on a 3-month old.

Q: How difficult would it be to reconstruct a tragus on an infants ear?

Dr. Wallace: It sounds like your child has a mild form of hemifacial microsomia. She needs to be evaluated by a craniofacial surgeon. I'm the only fellowship trained craniofacial surgeon in Memphis, so you can call my nurse, Tracey at 347-8290 to schedule a consultation.

Q: What is the recovery time for a breast reduction and also if breast cancer runs in your family will this cause any problems with the reduction?

Dr. Wallace: The recovery time is about two weeks for breast reduction. A family history of breast cancer will not cause any problems with a breast reduction. It just should be a warning for you to do regular examinations and mammograms if age is indicated.

Q: Any recommendations for of surgeons for breast reduction?

Dr. Wallace: We have three very skilled surgeons in our group who routinely do breast reduction surgery with very nice outcomes. Appointments for myself or Dr. LaChicacan be made by calling Tracey at 347-8290.

Q: I am a size 32f and 5'4", 136 lbs - Am I a good candidate for a breast reduction?

Dr. Wallace: Yes, you are a good candidate because you are a petite woman, not overweight, and with a large size breast. That's the criteria to have the procedure approved by insurance.

Q: What is involved in a breast lift? Is the recovery time longer?

Dr. Wallace: Recovery time is about 1-2 weeks. It involves re-lifting the nipple and removing excess skin, and reshaping the breast.

Q: :what is the basic criteria for insurance companies to pay for reductions? What if the person is 20 pounds overweight but she is still a dd?

Dr. Wallace: Many insurance companies use a height and weight chart that is only known to their reviewers. The only way to know for sure is to send a letter of predetermination asking for approval.

Q: My daughter, a medium complexion African-American girl has a small scar on her forehead can this be made invisible?

Dr. Wallace: It may be possible to make it better but is unlikely that it could be made invisible. We can't make scars disappear; we can hopefully improve them and camouflage them.

MODERATOR: Thank You for your time Dr. Wallace and thank you all for logging in today. Again, if you have any questions, feel free to call, Tracey Snider, at 347-8290. She will be able to answer many of your questions and mail you brochures about the various procedures. Information can also be obtained by going to www.plasticsurgery.org.

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