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Cosmetic Surgery with Dr. Csaba Magassy

Csaba L. Magassy, M.D. F.A.C.S.

Moderator: Welcome to Viewpoint with our guest, Dr. Csaba L. Magassy. Dr. Magassy, thank you for joining us, and let's begin.

Arlington, Va.: I have a deviated septum and have also been considering cosmetic rhinoplasty. Is it likely my insurance will pay for the surgery?

Dr. Csaba L. Magassy: Thank you. I am glad to be here. To answer the first question, I believe that the insurance company will definitely pay for the septum, but probably will not pay for the cosmetic aspect of the rhinoplasty unless it is associated with a traumatic event such as an automobile accident.

Washington, D.C.: I have been considering having something done to my abdominal area. I have had three children and no matter how much weight I lose I can never get rid of my abdominal area. Any suggestions as to what is the safest procedure?

Dr. Csaba L. Magassy: Probably the easiest and the safest procedure would be ultrasound lipectomy which in essence is a sophisticated form of liposuction. The positive aspects are that it will remove volume (fat) and it will shrink the skin to a great degree, but it will not tighten the abdominal wall.

Washington, D.C.: Dr. Magassy, thank you for being here today. My question has to do with a breast lift (not sure whether this is the right terminology). I am not looking for augmentation or reduction, just a lift. My breasts have been droopy ever since they appeared, possibly because I gained some weight at the same time that I hit puberty or because my breasts tend to swell with PMS. I am now 29. Over the years I have lost and gained substantial amounts of weight, and my cup size has varied from a B to a D. I am approaching a 90-pound weight loss goal on a healthy, moderate program that I believe I can continue indefinitely. I've promised myself that if I can keep the weight off for a year I will treat myself to a "breast lift," that as I understand it, would involve removing some of the skin around the areola and reattaching the areola (please correct me if I'm wrong) to make the breasts look firmer and higher. My concern is that I am planning to have children and to breastfeed. Would such a procedure interfere with breastfeeding later on? What impact would the weight gain and swelling of pregnancy have on the lasting effect of the procedure? Should I wait until after having children? Thanks.

Dr. Csaba L. Magassy: The breast lift itself, which is called a mastopexy, involves the tightening of the skin brassiere without removing volume, thereby literally lifting the breast. It does not take away from the possibility of breastfeeding. The drawback is that with pregnancy and weight gain the drooping will return to some extent. Probably, if you want a long-standing result wait until after you have children to have the surgical procedure performed.

Tysons Corner, Va.: Ever since I was a child, I have had I guess what you would call very little differentiation between my chin and my neck. This makes for a less attractive profile and often a double chin look. What type of procedure might remedy this, and where would there be scars?

Dr. Csaba L. Magassy: Depending on your age, if you are in the younger category and have good elasticity of the skin, the easiest procedure is an ultrasound submental lipectomy. This will remove the excessive fat and will probably shrink the skin. Adding this with a chin implant, which involves an implant at the front of the chin, will give you a much more attractive profile and a big difference between the neck and the chin. If by any chance your skin is not very elastic, and you don't fit these criteria, a chin implant and a neck lift is the procedure to do.

Fairfax, Va.: Dr. Magassy, I have been researching, and am subsequently interested in, the Scarless Breast Reduction. I am 25, with no children, in good health, and wear a 36G. My BMI is 28. What can you tell me about this procedure? Is it currently being done in this area (I haven't been able to find anyone)? How do you and your colleagues view it? What constitutes a good candidate? What appeals to me most is that the ability to breastfeed is retained. How accurate do you believe that statement to be? Thank you so much for your time. I don't want to make a bad decision!

Dr. Csaba L. Magassy: The Scarless Breast Reduction surgery involves volume removal with an ultrasound lipectomy device. Depending on the amount of glandular tissue and fiber fatty tissue, you would be an excellent candidate for this procedure. The volume removed would be only the fiber fatty tissue and not the glandular tissue. So you would have to assess the amount of fiber fatty tissue versus the amount of glandular tissue you have to determine if you are a candidate for this procedure. We do this procedure and any qualified plastic surgeon who has access to an ultrasound machine should be able to perform this procedure as well.

Washington, D.C.: What's the best procedure to remove dark spots/post-acne from African-American skin?

Dr. Csaba L. Magassy: It involves a whole series of skin care treaments, and probably the best known is the Obagi System.

Alexandria, Va.: Dr. Magassy, I am seriously thinking about breast augmentation. I see a very noticeable size difference in my breasts. I am 24, and unsure if I ever want to have children. Would having children ruin breast augmentation?

Dr. Csaba L. Magassy: The augmentation procedure is a perfectly safe procedure. Most of the time it is placed behind the breast and behind the muscle thereby becoming a dynamic spacer. You should be able to breastfeed and have children without any significant difficulties. The beauty about having breast implants after children is that they are non-biodegradable, thereby providing the form and shape after pregnancy and lactation.

Arlington, Va.: What is a tummy tuck? I have a lot of loose tummy skin from my pregnancy that just isn't springing back to where it was. The stretch marks are awful and no amount of situps is taking care of the sagging skin. Can this be fixed by a tummy tuck and what would be the price (a price range is fine)? Thank you.

Dr. Csaba L. Magassy: The tummy tuck is technically known as an abdominoplasty. It involves tightening of the abdominal wall and excising sagging stretch-marked skin. Price range is $7,000 to $10,000.

Charlotte, N.C.: Is Botox safe and how expensive is it?

Dr. Csaba L. Magassy: Botox is a safe toxin that when reconstituted and injected into the proper muscle groups creates a pleasant optical illusion of facial expressions. It costs anywhere from $300 to $600 depending on the number of sites used.

Alexandria, Va.: I'm a 53-year-old woman. I have always received compliments on my complexion and skin, but lately have noticed my eyelids getting a bit droopy. What would be involved in getting just an "eyelid lift," if that's the correct name for the procedure? Rough range of costs?

Dr. Csaba L. Magassy: The procedure that you are asking about is a blepharoplasty, commonly performed on the upper and lower eyelids. This consists of removing excessive skin, removal of a portion of the fat pads and tightening the skin. The price range is $3,500 to $5,000.

Arlington, Va.: I am interested in laser hair removal on my face and underarms. Can you tell me how effective this really is, and what the possible complications can be? There are several centers in the D.C. area that do this and I want to know how to go about choosing the right one. I'm fair skinned with dark hair, so I'm told I'm an ideal candidate, but since this is so new, I find it difficult to get accurate information that isn't marketing propaganda. Thanks for having this discussion.

Dr. Csaba L. Magassy: Laser hair removal is very effective in the properly selected patient. If you are fair skinned and have dark hair roots, you are the ideal candidate. It involves a series of three to five treatments, because the laser hair removal treats only the hair in the growth phase.

Arlington, Va.: Dear Dr. Magassy, I have contemplated breast augmentation for eight years, since age 20. I am aware of the risks involved, yet find the benefits very attractive. Do you believe that the risks are to different degrees relative to the implant size and the size of the natural breast? Due to my petite figure and very active lifestyle, I have always been interested in a modest augmentation (A to B). Does a more modest choice hold any advantage in risk-mitigation (specifically, capsular contracture and other longer-term problems)? Or am I just naively hopeful?

Dr. Csaba L. Magassy: If what you want is a very modest augmentation, there is a system called the Brava System which is the first non-surgical breast augmentation system. It involves wearing a device that will grow your own tissue in a period of 10 to 12 weeks. It is your own tissue, so it is not an artificial material. This involves no risks because it is your own tissue. On the other hand, if the augmentation you desire is more than modest, the surgical procedure could be your choice. Regarding the safety of breast implants, particularly saline implants, there's over two million women-years in the United States to testify to their safety.

Washington, D.C.: Dr. Magassy, I have very full ethnic lips. Is there a surgical procedure that is relatively safe that can be performed that will make them smaller? If so, how long would one have to be out of work, what are the risks and what is the cost? Thanks.

Dr. Csaba L. Magassy: The full ethnic lips are decreased with an incision on the inside of the upper and lower lips. It involves a surgical procedure with a modest amount of sedation. You should recuperate within a week. The price range is $2,000 to $3,000 for both upper and lower lips.

Washington, D.C.: Hello Doctor and thank you for taking the time to answer questions. I underwent a breast reduction a year ago and a follow-up surgery since. My breasts are now visibly uneven to me. How would one get a second opinion without having to reveal the name of her intial physician? Any why would another physician refuse to see me until I name him or her? I don't want trouble, just some help. Thanks.

Dr. Csaba L. Magassy: We render second opinions all the time. We would be delighted to take a look and see what we could do in order to improve your results. One look is worth a thousand words.

Phoenix, Ariz.: I am planning on having Botox injections in a week and my husband is concerned because we are going to try to start conceiving our second child in June. In your opinion, would it be safe to do this now or should I wait until I'm finished breastfeeding this child? Thanks for your advice.

Dr. Csaba L. Magassy: It is perfectly safe. Botox has no effect at all on pregnancy or the ability to conceive.

Washington, D.C.: Hi, I always wanted to have the breast enlargement surgery done but heard that it can be painful, especially the recovery. Have there been any advancements in this type of surgery? Is it really as painful as they say? Also, I heard about tummy surgery that uncovers your "six-pack" if you already have muscles there to start with -- can you provide any insight on that? Thank you so much for your help on both of these issues.

Dr. Csaba L. Magassy: In our practice we routinely perform intercostal blocks with Marcaine, which is a long-lasting (up to 12 hours) local anesthetic, thereby significantly decreasing the amount of pain and discomfort from the stretching of the skin and muscle for the breast implant. Liposuction, particularly the ultrasound system, removes the fat on top of the "six-pack" thereby giving you the contour you so desire.

Arlington, Va.: What is the best treatment for red broken veins on the face, especially on the cheeks and around the nose?

Dr. Csaba L. Magassy: KTP laser, which will completely ablate and coagulate the blood vessels.

Washington, D.C.: I am very interested in getting breast implants for cosmetic reasons. I am, however, concerned about nipple sensation (mine are very sensitive and I like it that way!) and breastfeeding should I ever have children. Could you share some insight into these concerns? Thank you.

Dr. Csaba L. Magassy: Breast augmentation, particularly when approached from the inframammary fold, provides the least amount of disruption of the nerve endings, thereby keeping you fully sensate. It is a perfectly safe procedure if done by a qualified physician.

Washington, D.C.: Dr. Magassy, I would like to have a breast lift. Could you please tell me more about scarring? I'm really nervous about visible scars. I notice that I tend to scar easily, which I believe is mainly because I have olive skin (European Spanish descent). Do you think I would be a poor candidate for this procedure? Thank you, Dr. Magassy, for answering my question.

Dr. Csaba L. Magassy: Basically, a breast lift involves a scar around the areola, from the point of the areola down to the fold. Fortunately, these scars fade very nicely and do not pose much of a problem. But like everything else, it is a trade-off.

Columbia, Md.: Dr. Magassy, I recently read "The Wrinkle Cure" by Nicholas Perricone, M.D. What is your opinion of this book, if you have read it? I currently use Obagi products, follow the dietary suggestions in the book and take a daily multivitamin. I am 41, with fair skin. Thanks!

Dr. Csaba L. Magassy: My opinion of the book is that I basically agree with everything he says. It is a straightforward book, with certainly very valid concepts and you are on the right track by using the Obagi products. Being that you are fair and 41, the only thing I would add is to please stay out of the sun and use plenty of sunblock.

Dr. Csaba L. Magassy: I have enjoyed participating with the questions and answers. Please visit our Web site for more information. Have a pleasant day.

Moderator: Our thanks to Dr. Csaba L. Magassy, Plastic Surgery Associates, P.C., and all who participated.

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