Back to the Gym Program

As we do Los Angeles plastic surgery, we find that many of our patients lead active lifestyles. Some people have told us of their concern that having plastic surgery will keep them from working out and going to the gym for many weeks and months following their procedure. That’s why we’ve developed our Back to the Gym Program. By working closely with you, we often can get you back to exercising shortly after plastic surgery – while maintaining your safety and assuring that you stay on course to have the best possible result from your procedure.

Our Back to the Gym Program involves several steps:

• During your plastic surgery consultation, we review your medical history. If there is a medical reason or indication, we arrange for you to be evaluated by a primary care physician or, if indicated, by a specialist. We review your typical exercise regimen with you in detail.
• Once we decide which cosmetic surgery procedure you will be having, we begin planning what sorts of exercises are safe for you and when you might begin them.
• Depending on the procedure you undergo, we arrange for you to obtain specialized garments to protect the areas of your body we worked on.
• During and after your surgery, we implement our Minimal Pain Program, which helps you feel less discomfort following your procedure so you can return to normal light activities more quickly.
• We see you several days after your surgery, before you begin to work out. During this visit, we confirm that your recovery is going as expected.
• We then discuss very specifically what sorts of exercises you can begin doing and when. We tell you warning signs to watch out for, and should make you slow down your activities. We arrange for your plastic surgeon to speak with your personal trainer, if you use one. If you’d like, we have trainers we work with and we can arrange for you to exercise with these professionals after your surgery.
• We maintain close contact with you, both by phone and frequent office visits, to make certain that your physical activities continue to go smoothly without slowing your overall recovery.

There will of course be limitations to the types and intensity of exercises you can do and when you can start doing them. And if you experience any warning signs of overexertion you must stop what you are doing immediately. Our Back to the Gym Program requires good communication and frequent visits to our office. But we find this extra effort on our part and yours improves the overall plastic surgery experience for many of our patients. The program can be applied to all procedures we do, such as Los Angeles breast augmentation and Beverly Hills tummy tuck as well as liposuction, among others.

Lloyd M. Krieger, MD is the founder and medical director of Rodeo Drive Plastic Surgery in Beverly Hills, CA. He welcomes your questions and comments by phone at 310-550-6300 or email at

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Each Father's Day Rodeo Drive closes down to host its annual car show. While every day seems like a car show on the street, with its Bentleys, Ferarris, and Lamborghinis cruising the boulevard, at this event the the cars are parked along the street. The show features both new and antique exotic cars and attracts a very nice crowd. People travel from around the country both to show their cars and to see them. I was happy to go to the event this year with my mom and dad for Father's Day.

This is the sort of event that makes happy to be located right on Rodeo Drive. The very small local community on the Drive does tend to stick together and work toward providing an environment that is both sophisticated and welcoming. Of course, we could have designed and built our plastic surgery center anywhere in town. After all, it is possible to perform Los Angeles liposuction or Beverly Hills breast enlargement in many locations. But by being a part of the local Rodeo Drive community, we are constantly in touch with the latest lifestyle, fashion, and customer service trends.

Because of this close association with our elegant neighbors, we are in the best position to constantly improve the services we provide. We also have a great feel for fashion design and this helps us remain at the cutting edge of plastic surgery. Our philosophy is that at its core Beverly Hills plastic surgery is about helping people achieve their desired lifestyle. And by interacting closely with our boutique neighbors we gain a constantly evolving understanding of new lifestyle trends -- from those who are the ultimate tastemakers and trendsetters. Rodeo Drive Community events like the annual Rodeo Drive Car Show keep us in touch with our neighbors and spur our efforts to constantly improve the plastic surgery service we provide for our patients.

Mammograms in those with breast cancer predisposition

Lots of new interesting things continue to come out in my areas on interest.

Today, in Britain's Journal of Clinical Oncology, specialists said women genetically predisposed to developing breast cancer should consider asking for MRI scans, which do not use radiation, instead of mammograms. A news summary of it can be found here

This study retospectively questioned about 1,600 patients identified as high risk for breast cancer. These women, who possessed one or both of the well-known BRCA-1 & BRCA-2 genes that predispose them to breast cancer, may in fact be at significant risk for developing cancer from an imaging procedure which has been considered to poses little risk to women. These patients demonstrated an increased risk by as much as 2.5x by age 40, which is a staggering figure in risk analysis.

The researchers propose that radiation may be very risky for BRCA mutation carriers as those genes are believed responsible for repairing DNA damage, such as that from the ionizing radiation of x-rays. Defective genes would thus be less able to repair radiation damage, and result in more malignant cells developing.

The study "is not enough to mandate changes in clinical practice," said Dr. Kathy Albain, director of the breast research program at Loyola University Medical Center in Maywood,IL. "But I think it's enough to modulate our recommendations for certain patients.

A few things to keep in mind on this:
1. The study wasn't prospective
2. Most breast cancer cases (>90%) do not involve BRCA 1 & 2 genes
3. This finding has not been observed (yet) by other researchers
4. More prophylactic mastectomies are likely to be recommended in these patients

This is potentially big news thought for what may be a hastening of the eventual change to MRI mammograms being used more widespread which will be a good thing.

Rob Oliver

The hits keep coming....

This is becoming redundant I know, but there continues to be a flurry of new literature and announcements re. breast implants and their safety.

Following in the heels of April's report on the lack of cancer risk found in Danish implant patients in the Journal of the National Cancer Institute (see recent blog entry below), a publication about to be released in the American Journal of Epidemiology reports that a cohort of nearly 25,000 patients in Canada were observed to have a whopping 43% lower incidence of breast cancer and across the board lower mortality rate for all cancers.

A summary by CNN online can be read here

These two reports do not give evidence to suggest a protective effect of implants, but probably reflect a selection bias of patients choosing breast surgery. Presumably these patients are younger, healthier, and with less breast tissue then society at large. There have been some left-field theories on how the presence of implants could be tumor-supressive by lowering the temperature of the adjacent tissue or that there could be an immuno-stimulatory effect of a foreighn body. Neither of these ideas has been examined in a meaningful way.

The take home message: There appears (at this time) to be no evidence in multiple, well-done studies of a causitive relationship between breast implants and cancer.

In April, the Washington Post featured a story on a report that new, highly reactive species of Platinum free radicals were found in patients with silicone implants. This story was immeadiately seized upon by groups who have been fighting against liberalized reintroduction of silicone breast implants in the United States. In fact, the study referred to, was in part funded by one of these groups.

The Washington Post feature was not particularly partisan, but it did seem to highlight a single study out of context to the body of literture on platinum chemistry, which to that point was pretty dismissive of associations to toxicity. The article did however, get picked up in some scattered newspapers.

Just this past week the FDA updated their information page on breast implants and platinum and they made some interesting statements. Of the study referred to in the Post, they characterized it as have so many flaws as making it of "limited value". Irregular tests performed in the study and control groups makes interpretation difficult, and they point out that several members of the control group had higher levels of platinum then those with the implants.

They conclude that in vivo properties of platinum "do not represent a significant risk to women with silicone breast implants" which is consistant with their previous position, the 1999 Institute of Medicine report, the United Kingdom medical device committee, and a number of other reviews.

The publication of such a strongly worded position on the FDA site makes it seem likely to me that concern over platinum is unlikely to figure much in the timetable for the reintroduction of silicone implants.

The Importance of an Accredited Surgery Center

The Wall Street Journal recently ran a detailed article on the importance of having procedures done in an accredited surgery center. I could not agree more. An accredited facility is one of the most important ways you can work toward having the safest possible plastic surgery experience.

Our facility -- Rodeo Drive Outpatient Surgery Center -- is accredited by the AAAHC and Medicare. This means we are inspected for such things as our physical layout, equipment, staff training, medical records, and history and background of our physicians. We have all necessary safety equipment on site. We keep emergency medicines available at all times. We have a transfer agreement with a local hospital. When we do procedures using anesthesia, we use physician anesthesiologists. We use our safe operating rooms even when we do smaller procedures without anesthesia. One example is liposculpture without anesthesia. All of these things are part of our accreditation and they are always at work preserving patient safety as we do procedures.

If you have any questions about the safety measures employed during our procedures, please do not hesitiate to contact us.

Echoing the the theme I mentioned previously, multidrug resistant Staph. infections (MRSA) are popping up more and more. The newswire today features a story infections in several states from improperly cleaned tattoo instruments.


I found a great blog called Boobumentary following a patients recovery from recent breast augmentation. This is very illustrative of the early recovery and common experiences after many women's surgery.

This report in the April 19 Journal of the National Cancer Institute is fairly recent and something I meant to get around to highlighting.

An April 2006 report from the National Cancer Institute updated the world's most comprehensive long-term study of women with silicone implants and their risks of various cancers. Cancer-producing potential was one of the various claims made during the silicone histeria of the early 1990's.

In the report nearly 3500 women, who've been followed for an average of 18 years. Only 53 of the women developed breast cancer, compared to 71.9 cases that would have been expected in the general population. There were 180 total cancers in women with the breast implants, slightly fewer than the 193.1 that would have been expected. The women who received breast implants were more likely to develop lung cancer than other women: 20 developed it, compared to the 9.1 that would have been expected to have it. The researchers think this is because the Swedish women with implants were more likely to smoke.

This study is more reassuring information that continues to come in on the long-term safety of silicone implants.

Skin Activating Liposuction

At Rodeo Drive Plastic Surgery, we are doing a lot of liposuction as people get ready for the summer. We now do our procedures with a technique we call Skin Activating Liposuction and have been very excited by the results. With our Beverly Hills liposuction procedures, we add an extra step to the process. We intentionally irritate the underside of the skin. When skin is irritated in this way, it tends to heal with some internal tightening. This approach works to help the skin shrink more tightly, so once the fat is removed the resulting overall contour should be improved.

We have found that the technique works very well for subtle treatments such as chin and neck liposuction. In cases such as this, the extra skin shrinking defines the angle of the jaw more cleanly and sharply. The procedure is also very useful for larger volume liposuction, such as that shown in the photos above. When we are removing four or five liters of fat, the skin has a lot of shrinking to do. This technique helps to stimulate the process.

In many cases, though, even Skin Activating Liposuction will not do the job. If there is too much extra skin, or if the skin has been over stretched (which is the case whenever there are stretch marks) then other procedures are necessary that actually remove skin. Such procedures as tummy tuck and thigh lift will provide improved contour in these situations.

We can tell you which procedure -- our Skin Activating Liposuction or another technique that actually removes skin -- will work best for you based on your body type and current situation. When we examine you we will tell you our recommendations!

To "T" or not to "T", that is the question...

One of the trends in breast reduction surgery is the trend towards "short-scar" procedures which minimize or eliminate the traditional horizontal part of the incision.

Seen below is a figure of the traditional "Wise Pattern" reduction using tissue from the lower part of the breast (an 'inferior pedicle technique') to keep the nipple & areola alive. It produces a scar that looks like an upside-down anchor and has been the standard procedure used in breast reduction for decades.

Work from surgeons in Europe & South America has trickled down to the United States using both shorter vertical scars with pedicles often oriented superiorly or medially. Below is a figure of a superior-medial pedicle which has been popularized by Canadian Plastic Surgeon, Dr. Elizabeth Hall-Findlay.

The advantages purported by this rethinking of the classic Wise-pattern/inferior pedicle surgery include using breast tissue (as opposed to skin) to maintain shape. Whether this holds up over time, we'll have to see. I've done a number of these & had some unpredictable results. They either are fantastic or just so-so. Unlike the traditional operation you rely on post-op settling of the breast to get the finished result which leads to some funky-shaped breasts leaving the table.

The most common problems I see are too high a nipple position & a persistant "pucker" at the bottom of the incision. Some puckers resolve, but a number require minor revisions in the office. It's always tempting to compromise the technique and use short-T's or j-shaped cut-outs of the pucker during the initial surgery.

Noninvasive Plastic Surgery and Facial Rejuvenation

The "lunchtime facelift" has been the holy grail in plastic surgery for quite a while. The idea of providing facial rejuvenation with no downtime appeals to both plastic surgeons and patients. Get your treatment, look improved and freshened, and immediately go back to work or out on the town or, for some of our entertainment patients here in Beverly Hills, head over to the red carpet at an awards show. Who wouldn't want to get their facial rejuvenation and then have no recovery?

Essentially all of the so called "no downtime facelifts" or "lunchtime facelift" simply did not live up to their billing. As a plastic surgeon, I know that surgery involves recovery. It is just the way the body responds to a surgical procedure.

But now we have many nonsurgical techniques that can create instant facial freshening -- removing or smoothing wrinkles, plumping lips -- with no recovery. Botox, Restylane, Juvederm, Radiesse, Sculptra and other new products provide facial rejuvenation and do not create scars or undue swelling. They can help achieve that elusive goal of improvements without downtime.

These products work very differently. When we do Los Angeles Botox we are using the chemical to paralyze some of the tiny muscles in the face. The twitching of these muscles creates a skin wrinkle on the skin that lies above it. Botox is extremely safe, its results are predictable, and can create fantastic improvements in facial appearance. My sister recently had it for the first time, and it dramatically improved and freshed the look of her face.

The Los Angeles skin fillers such as Restylane and Juvederm provide bulk under the skin to fill in wrinkles from below. They are very effective for both small lines and larger ones, such as the nasolabial folds which run from the sides of the nose toward the outside edges of the side of the mouth.

Each person's face is different, so each person will do best with a different noninvasive treatment. But the various procedures do provide fast changes with little or now recovery.
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