Who Gets Plastic Surgery?

One thing that I continue to be impressed with is the wide cross section of people who come to us for plastic surgery. We see people of all ages. Men and women. Every ethnic group. From all over the local area and from all over the world. People seek Palm Springs plastic surgery, just like people from Beverly Hills, the Valley, or the South Bay. The most interesting thing is that the motivations are similar even for these diverse people. They want to feel more comfortable with themselves. Yes, it is about appearance. But it is really about how comfort with appearance allows people to be more comfortable with themselves overall. So the answer to the question, "Who gets plastic surgery?" is that many different people do. And that the reason that all these diverse people do is to enhance their overall comfort levels with themselves and their lifestyle.

Drs. Abbott Krieger and Lloyd Krieger Develop Innovative Surgery to Help Breathing

At Rodeo Drive Plastic Surgery, in addition to the usual cosmetic surgery procedures such as Los Angeles tummy tuck and
breast augmentation, we also provide innovative breathing surgery.

Below are excerpts from two articles about a unique procedure to help people previously confined to a ventilator for life. The research behind the procedure and its development was done by Abbott Krieger, MD, the father of our Medical Director. Dr. Abbott Krieger did basic research on the concepts for this revolutionary surgery. He then pioneered its use clinically. The procedure uses a nerve transfer technique to allow the phrenic nerves to once again stimulate the diaphragm to move air, allowing patients to breathe without the need for a ventilator.

From New Scientist---
PEOPLE who face spending the rest of their lives on ventilators may be able to breathe on their own again with the help of a new surgical technique.

To help people breathe normally when they're disabled by spinal cord injuries, surgeons often implant a pacemaker that stimulates the phrenic nerve, which cues the diaphragm's breathing motion. But this doesn't work if the nerve has also been damaged. Now Abbott Krieger, a neurosurgeon in Livingston, New Jersey, says that he can repair phrenic nerves so they respond to the pacemaker.

Abbott Krieger MD takes a nerve that goes to a chest muscle and grafts it on to the dead phrenic nerve. After a few months, he says, the phrenic nerve becomes functional again and the pacemaker works—so the patient can live without a respirator.

Neurosurgeons use this type of nerve grafting to repair more peripheral nerves such as those in the face, but never in the deep chest cavity where microsurgery is difficult. Krieger's procedure was successful in five out of the six patients he treated, he told the Congress of Neurological Surgeons in Boston this week.

From Plastic and Reconstructive Surgery---

The Intercostal to Phrenic Nerve Transfer: An Effective Means of Reanimating the Diaphragm in Patients with High Cervical Spine Injury

Nerve transfers have been well described for the treatment of congenital and traumatic injuries in the brachial plexus and extremities. This series is the first to describe nerve transfers to reanimate the diaphragm in patients confined to long-term positive pressure ventilation because of high cervical spine injury. Patients who have sustained injury to the spinal cord at the C3 to C5 level suffer axonal loss in the phrenic nerve. They can neither propagate a nerve stimulus nor respond to implanted diaphragmatic pacing devices (electrophrenic respiration).

Ten nerve transfers were performed in six patients who met these conditions. The procedures used end-to-end anastomoses from the fourth intercostal to the phrenic nerve approximately 5 cm above the diaphragm. A phrenic nerve pacemaker was implanted as part of the procedure and was placed distal to the anastomosis. Each week, the pacemaker was activated to test for diaphragmatic response. Once diaphragm movement was documented, diaphragmatic pacing was instituted.

Eight of the 10 transfers have had more than 3 months to allow for axonal regeneration. Of these, all eight achieved successful diaphragmatic pacing (100 percent). The average interval from surgery to diaphragm response to electrical stimulation was 9 months.

All patients were able to tolerate diaphragmatic pacing as an alternative to positive pressure ventilation, as judged by end tidal CO2 values, tidal volumes, and patient comfort. Intercostal to phrenic nerve transfer with diaphragmatic pacing is a viable means of liberating patients with high cervical spine injury from long-term mechanical ventilation.

Plastic Surgery Without Pain

Prior to undergoing plastic surgery, many of our patients express concern about how much pain they will have during recovery. To meet this concern, we have taken steps that work to minimize post-procedure pain. We call our system Rodeo Drive Plastic Surgery Rapid Recovery.

While it is difficult to make any surgery completely pain free, we have succeeded in making our procedures very low pain. This allows patients to be comfortable from the moment the procedure is completed and our nurses take care of them in the recovery room, to when they continue their recuperation at home. Our goal is to make post-procedure pain something akin to the soreness that accompanies a very strenuous workout at the gym. This applies to all procedures, everything from Beverly Hills liposuction to tummy tucks.

Many of our patients travel from out of town, so Rodeo Drive Plastic Surgery Rapid Recovery helps them remain comfortable in the unfamiliar environment of a hotel, in the car for a sometimes long drive, or on the plane flight home some days later.

The program involves our surgeons, anesthesiologists, nurses, and patients all working together to minimize pain. Each of these individuals has a key role in working to minimize post-procedure pain.

Rodeo Drive Plastic Surgery Rapid Recovery begins well before surgery day. This phase takes the form of educating patients about the program and the steps we will be taking to minimize pain. Once concerns are alleviated, patients continue the process toward surgery much more comfortably. The program continues during all aspects of surgery through recuperation at home.

Rodeo Drive Plastic Surgery Rapid Recovery consists of these steps:

--Providing patient education before surgery

--Giving patients prescriptions for narcotics and anti-nausea medicine for their recuperation

--Using a physician anesthesiologist during every cosmetic procedure, to ensure patient safety and to administer pain and anti-nausea medications during the surgery

--Doing all our procedures in a AAAHC and Medicare certified surgery center, to assure the highest standards in our patient care, safety, medications, sterility, lighting, and equipment

--Employing extra-gentle tissue handling techniques during plastic surgery, to minimize trauma and resulting pain

--Applying long-acting local anesthetics to all surgical sites at the end of the procedure, so pain centers are not stimulated during early recuperation

--Communicating with patients when they first awake using a nurse-patient interactive pain picture chart, and giving pain medicine as soon as patients report discomfort – before the onset of any true pain (see picture chart above)

--Remaining in close contact with patients during their recuperation, to make certain their pain is controlled -- and altering pain medicines if necessary

Patient response to Rodeo Drive Plastic Surgery Rapid Recovery has been excellent. It is important to stress, however, that even though patients may have very little pain following surgery they must still limit their physical activities so their recovery can proceed without complication.


Lloyd M. Krieger, MD is a California cosmetic surgeon and the founder and medical director of Rodeo Drive Plastic Surgery in Beverly Hills, CA. Specializing in Nip/Tuck Rodeo Drive, Dr. Krieger offers all plastic surgery procedures. And while the center has many clients from the entertainment industry, they offer more than just celebrity plastic surgery! Dr. Krieger welcomes your questions and comments by calling our Los Angeles plastic surgery center at 310-550-6300 or by email at info@RodeoDrivePlasticSurgery.com.

More information can be found at http://www.rodeodriveplasticsurgery.com/.

A Novel Approach to Breast Reduction

At Rodeo Drive Plastic Surgery, we are always trying to take advantage of our environment here on Rodeo Drive. The fashion boutiques next door and down the street give us a lot of information about style and trends. One way we recently did this is with our approach to breast reduction surgery.

Breast reduction surgery has the potential to greatly improve quality of life. For people with overly large breasts, the symptoms of neck pain, back pain, headaches, and limitations on activity often can be instantly alleviated by breast reduction surgery.

Among plastic surgery procedures, breast reduction is especially challenging. The three dimensional nature of the breasts, combined with the need to change their position and shape in addition to size, makes breast reduction surgery a complex undertaking. We have found that people coming for breast reduction surgery are seeking to improve not only their appearance but their overall lifestyle. They want to look better and feel better. They want to be more active. They want to wear elegant clothes that have previously been off limits to them.

To meet our patients’ goals, we looked to our neighbors on Rodeo Drive. We worked with these boutique managers and style makers to better understand the types of body shapes that best fit into fashionable clothing. In each breast reduction procedure, we not only address breast size, but also their shape and position. This way, the final breasts after our Los Angeles breast reduction match the body to create a harmonious overall shape. We call our approach the Rodeo Drive Shaped for Fashion Breast Reduction.

Our goal for Beverly Hills breast reduction is to create the size and shape that will allow our patients to look good, feel comfortable, and give the widest options for wearing all types of fashionable clothing. Our Rodeo Drive Shaped for Fashion Breast Reduction goes beyond simply reducing the size of the breasts. it joins many of our other procedures we are proud to innovate for our patients, such as our novel neck liposuction procedure, among others.