Plastic Surgery Q&A

Choosing a Plastic Surgeon

Why should I choose a board certified plastic surgeon?

Answer: A board certified plastic surgeon is the gold standard for cosmetic surgery procedures. A board certified plastic surgeon has gone through 4 years of medical school and 6-8 years of advanced training in surgery. The last 2-3 years of surgical training are specific to plastic surgery. In order to be board certified, surgeons must pass both written and oral exams and are held to the highest standards. Board certified plastic surgeons must also complete continuing education and are subject to ongoing scrutiny by their peers. I am fortunate to be doubly board certified in general as well as plastic surgery.

What type of anesthesia will I need for surgery?

Answer: Most cosmetic surgery requires general anesthesia (being put to sleep during the procedure.) I perform most of my surgery in the Surgery Centers at the Lankenau Medical Center or at Bryn Mawr Hospital. Other larger cases are performed at the Main Operating room at the Lankenau Medical Center or Bryn Mawr Hospital. At these hospitals, a board certified anesthesiologist is in charge of sedating patients and keeping them comfortable during surgery. At Lankenau Medical Center, CRNA’s who are specially trained nurses, assist the anesthesiologist during surgery. This allows your operating surgeon to concentrate on the case and have the anesthesiologist concentrate on the keeping the patient comfortable and safe.

Are combined plastic surgery procedures safe?

Answer: Combined plastic surgery procedures are great for patients. They can save a patient from having to undergo anesthesia twice to have two separate procedures done. It also combines recovery times which make it less recovery time than doing two or three separate surgeries and recovering from each.
There are many surgeries that can be combined. The most common is breast and belly surgeries- called a “Mommy makeover.” The key is that the surgery should not take much longer than 5 or 6 hours. Over that time, the risks of complications increase.

For more information, call our office today at 610-896-6666 to set up a consultation with Dr. Hoffman.


Tummy Tuck

Is there anything I can do or take prior to a tummy tuck to help have a better outcome?

Answer: We offer a pre-op vitamin package that is started prior to surgery and is continued after surgery. Its combination of vitamins and natural supplements helps with energy, bruising and healing after surgery. Since instituting this program, I find that the patients who have taken the vitamins have in general an easier recovery with less bruising.

As for losing weight or any other things that can help prior to a surgery- I feel that the better shape you are in before surgery, the easier recovery you will have. People who exercise and eat healthy in general do better after surgery.

How do you get rid of stretch marks and loose skin on the abdomen and on the hips?

Answer: After childbirth and before considering an abdominoplasty (tummy tuck) you have to decide whether you are finished having children and has your weight been stable for the last couple of months? If both those answers are “Yes” then you may be an ideal candidate for a tummy tuck. A tummy tuck tightens the skin of the abdomen, by remove the area between the pubic area and the belly button. The resultant scar hides in the waist line and goes from hip to hip. This physically cuts away the stretch marks, which is damaged skin caused by the stretching that occurs during pregnancy. Liposuction can remove the fat beneath the skin, but it does not do as good a job of tightening the skin and will not remove stretch marks. Having a consultation with Dr. Hoffman, a board certified plastic surgeon, will help you to choose which procedures may be best for you.

Stretch marks on the hips are a very difficult problem. They are not easily cut out as stretch marks below the belly button. Our Viora machine, which utilizes radio-frequency does a good job of lightening stretch marks, sometimes a laser is also utilized to help minimize the appearance of stretch marks.

How long does tummy tuck surgery swelling last?

Answer: Swelling after an abdominoplasty (tummy tuck) can last for up to a year. Depending on the type of tummy tuck (mini abdominoplasty, full abdominoplasty, and modified abdominoplasty), swelling most commonly begins to resolve in about 2 weeks. Post operative garments are worn in order to help minimize swelling and achieve a final result sooner. In approximately 3 months, the swelling has gone down enough to envision a final result. At times at the end of the day due to dependent edema (fluid) the mid-portion of the incision or pubic area can swell, which is also temporary and can be improved with use of the post operative garments.

What exactly is a mommy makeover?

Answer: A mommy makeover is a combination of different surgical procedures that typically are requested by women who have had children. It involves procedures done to both the breasts and abdomen. Pregnancy and breastfeeding can cause negative appearances of the breasts due to changes in volume. The abdomen can have stretch marks, extra skin, or poor c-section scars. Pregnancy may also cause a separation of the abdominal muscles (diastasis), resulting in a persistent lower abdominal bulge. Despite diet and exercise, these issues do not improve on their own and require surgical intervention. A mommy makeover involves the combination of an abdominal procedure and a breast procedure. The breast procedures may include the following procedure(s): breast lift (mastopexy), breast reduction (mammoplasty), breast augmentation, and/or fat grafting to the breasts. The abdominal procedure involves abdominoplasty (full, mini, or modified) and liposuction. The surgical time is less when the procedures are done in conjunction with one another. The recovery time is about 2 weeks as opposed to 2 weeks and another 2 weeks of recovery when the procedures are separated.

What is a diastasis and can it be fixed during a C- section?

Answer: A diastasis is a separation of muscles that can occur with weight gain or during pregnancy. The connection between the midline muscles of the abdomen separate and result in a minor of large bulge of the abdomen depending on how much stretch has occurred. A small amount of diastasis is sometimes masked by strengthening of the muscles, but it cannot be fixed without surgical intervention. The stretch starts just below the rib cage and extends to the pubic area.

Sometimes patients are offered to have their muscles repaired by their OB at the time of a C-section. While this can be done, it causes a two-fold problem. One, during pregnancy the muscles as well as the whole body swells. When the swelling goes away the repair is not as tight as it could be and still may result in a bulge. Two, the repair is limited to only the area that is exposed during a C-section, which is only the lower half. This would only treat half the diastasis and could give a worse appearance to the abdomen. Discussing these issues, with Dr. Hoffman, a board certified plastic surgeon, is a good option prior to delivery.

Should I stay in the hospital overnight after a Mommy Makeover?

Answer: Most young and healthy moms can go home the same day following a Mommy Makeover surgery. The most common procedures that are combined are breast augmentation with a full tummy tuck (abdominoplasty). As long as there were no unforeseen circumstances during surgery, patients can be discharged home the same day. However, if the patient does not have adequate amount of help at home or feels that she will not get enough rest/downtime the night and day following surgery, then I recommend an overnight stay. An overnight stay can either be in the hospital (with a cosmetic price) or arranged to be in a hotel with a night nurse. These accommodations allow a mom to recuperate rather than having to take care of a household on her first postoperative day.

What are the purpose of drains following a tummy tuck (abdominoplasty)?

Answer: Drains are useful to minimize fluid in the dead spaces created after surgery. This can be in both breast as well as abdominal surgery. In breast surgery, drains are useful in revisional surgery or in patients who have greater than normal intraoperative oozing. The drains in this case help alleviate potential fluid, which may cause an infection or unwanted result. In an abdominoplasty, drains are used to help resolve potential fluid accumulation as well. In some cases, as in a “no-drain tummy tuck” drains are forgone in exchange for complex suturing underneath the skin. It does work well. However, it does make surgery longer and fluid collections could still possibly happen postoperatively. Drains are typically removed when the output is less than 30 ccs (1 oz) in a 24 hour period.

Can I have a hysterectomy and a tummy tuck performed at the same time?

Answer: There are many non-elective surgeries that can be combined with tummy tucks. Most commonly, hysterectomies and hernia repairs are done in combination with an abdominoplasty. This is coordinated between the gynecologist or general surgeon and the board certified plastic surgeon. The joint surgery allows for less time in the operating room and an overlap of recovery time. For more information, call our office today at 610-896-6666 to set up a consultation with Dr. Hoffman.

Can wounds or infections happen after a tummy tuck?

Answer: Wounds are not usual after a tummy tuck, but if they do occur, they are commonly in the central portion of the scar below the belly button. They are more common when larger hernia repairs are done at the same time. Occasionally, the binders that area placed post operatively can be secured too tightly. This restricts blood flow to the healing areas and can cause wounds. You should be able to slide your hand down into the binder and it should fit with minimal pressure. If you can not fit your hand inside then your binder or garment are too tight and should be loosened. Infections are also rare, but can occur. Usually they present as redness, pain, or drainage from around your incisions. If there are any concerns about your post operative incision please contact the office.

Is there ever a vertical incision (up and down) with a tummy tuck?

Answer: Occasionally along with the low abdominal incision, a vertical incision is utilized in a tummy tuck. There are two main reasons- One, is that the patient does not have enough skin laxity and a high belly button. The belly button is cut out and repositioned with a tummy tuck. When pulling the skin inferiorly the scar created from repositioning the belly cannot be removed. The area is then closed and a small vertical portion of the scar is in the midline connected to the low abdominal scar. The second type of vertical scar occurs in patients that already have midline up and down scars or for extra tightening after massive weight loss. An upside down T is created and that allows the most skin to be removed as possible. It however creates a scar that is not covered by your underwear. It comes down to what is more important for a patient, tight skin and more scarring, or loose skin and less scarring. Talk with Dr. Hoffman during an in office consultation for further information.

Should I lose 5 more pounds before my tummy tuck??

Answer: Generally binge dieting right before a tummy tuck is a bad idea. The best weight to be at is the weight that you can normally maintain with your usual diet and exercise. During surgery, your tummy tuck is set at that particular weight and after surgery when you return to your regular diet and exercise that is going to have the best looking result. If you diet and then after surgery gain 5-10 pounds your results may not be ideal.

Can a tummy tuck be combined with a bladder suspension procedure?

Answer: Yes, the procedures are commonly done together. I work closely with gynecologists or urologists who perform the procedure. We plan and do the procedures at the same time to combine the post op recovery period and save the patient extra time and procedures. If you do not have a gynecologist or urologists, Dr. Hoffman can help you find a qualified one.

For more information, call our office today at 610-896-6666 to set up a consultation with Dr. Hoffman.

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Breast Augmentation & Breast Lift/Mastopexy

I am a 39 year old with two kids. I’ve been told by three doctors that I need a vertical mastopexy and the options have differed by texture. One doc says that with a lift, smooth implants will often not stay “lifted” and patients come back after 6 months complaining that their breasts are sagging. Will a textured implant placed under the muscle sustain the lift better?

Answer: When using a round silicone implant, there are 2 types that can be used: one is a textured implant, the other is a smooth implant. The difference between the 2 is that a textured implant has stippling around the outside that are thought to prevent migration of the implant. With round implants, migration is not as large of an issue as with a shaped implant where some rotation would cause a noticeable change. In your particular case, when an augmentation mastopexy is performed, either a smooth or a textured implant could be used. Neither types of implants will stay lifted forever and surgeon preference should dictate which implant is to be used. In my current practice, with augmentation mastopexies I prefer a smooth, round implant.

After breastfeeding my breasts are deflated. Will I need a breast lift or augmentation to restore the appearance of my breasts??

Answer: It is very typical to lose volume after childbirth and breastfeeding. To figure out whether you would need a breast lift (Mastopexy) or an augmentation you have to figure out if you have enough volume. For example, if you are wearing a non-padded push up bra are your breasts a good size. If they are not full enough with a push up bra then you would need a breast implant to help with volume.

Once you decided whether you need an implant or not, the last question is whether you will need a breast lift at the same time as your breast augmentation. In general, the larger volume implants that you choose, the less of a lift people usually need.

Dr. Hoffman reviews these issues with patients during their consultations. He works with the patient so that they may achieve their ideal goals.

What is the best scar cream to use after breast augmentation surgery?

Answer: Scar care after any surgery is very important. At the least, performing scar massage twice a day until the scars have settled will help the scars look better. Scar massage consists of using a moisturizing lotion and gentle pressure placed on the scar. I recommend massaging in a circular motion for 2 minutes twice a day.

A step up from using just moisturizing lotion is a silicone based scar cream. I recommend this for scars on the face, cosmetic surgery scars, and patients whose scars have healed poorly in the past. In the plastic surgery literature, silicone has shown to be most effective in improving scar appearance. Silicone creams can differ in their consistency and content and that is why in my office we recommend -Silagen for my patients. It is only available for purchase through doctor’s offices.

I just finished breast feeding when can I get a breast augmentation?

Answer: Pregnancy and breast feeding can cause an engorgement of the breasts. After the cessation of breast feeding, the breasts typically take about 3 months to reduce in size and volume. That is why it is traditionally, surgeon like to wait about 3 months after breast-feeding has stopped prior to any breast surgery- augmentation, reduction, or breast lift.

Occasionally, there can be small amounts of milk expressed from the nipple even after 3 months. As long as it is only occasionally spotting, a patient can still go ahead with surgery. If it is more than occasionally spotting, I will have a patient revisit their OB for a check- up.

Are any new technologies being utilized for breast lifts or implant exchanges?

Answer: The newest advance in breast lifts or in particular breast lifts with implants are Acellular Dermal Matrixes or ADMs. They are material that we utilize in surgery for both breast reconstruction and cosmetic breast surgeries. The ADMs are used to strengthen and support the lower borders of the breasts. This can help place the breast fold in a good position and give a better cosmetic result. They act as scaffolds that your bodies’ cells repopulate with time.

There are also different shapes and sizes of implants that are available to us today that we did not have in the past. The use of these ADM’s and implants are part of the technology we use to help us get superior outcomes.

Is scarring necessary when doing a breast lift?

Answer: Yes. In order to tighten or elevate the breast tissue, scars are necessary. Some scars can be hidden beneath the breasts or around the areola. Other times visible scars are necessary in the inferior pole of the breast to tighten the loose skin. Breast lifts last around 10 years. Gravity is always pulling the breast downward and causing the breasts to sag.

Do I need a Breast Lift or a Breast Lift and Augmentation?

Answer: This is one of the most common questions that I get during my office hours. The answer differs from patient to patient. Generally, if you wear a bra without padding and like the appearance of your breasts with that bra, then just a breast lift may be the right choice for you. The breast lift may leave scars on the breast.

If you lack volume and need a padded bra to give you the look that you like, then an augmentation with or without a lift can be the right choice for a patient. An in office consultation helps clear up these issues.

How much fat do I need for a Breast Augmentation with Fat Grafting?

Answer: Fat can be taken from the abdomen, thighs, or hips area and can be moved to the breasts for augmentation. It can increase the breast about a cup size or can be used to help fill the breasts after childbirth. It is not good for increasing the breasts 2 or more cup sizes. A little over half the fat that is moved is permanent, but that can change if a patient gains or loses weight. (about 10 pounds.)

Fat to the breasts is a relatively safe procedure. It has been studied over the past ten years. There are concerns that more fat cysts or changes could show up in mammography which may require more views or possible biopsies of the breasts. Concerns have been brought up that there may be an increased cancer risk with fat grafting to the breasts, but that has not been shown in studies.

Dr. Hoffman performs fat grafting in the operating room.

I have seen pictures of breast implants on the internet and think I may have chosen to large of an implant?

Answer: Many patients search the internet prior to surgery to see how they may look after surgery. It can get patients quite anxious and scared prior to surgery. Choosing the correct sized implant is commonly the biggest concern for an augmentation patient. The problem is that even people with the same weight and height have very different chest widths and builds. Thus the same size implant may not look the same on those patients.

In the office I use a sizing system to help get an initial idea of the patient’s wishes. In the OR, I then using a sizing baloon and pick the size the looks best on the patient and is in line with their pre-operative wishes.

Talk with Dr. Hoffman and he will help you feel confident prior to the OR about your implant choice.

For more information, call our office today at 610-896-6666 to set up a consultation with Dr. Hoffman.

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Laser Hair Removal

What is the recommended length of time between laser hair removal treatments?

Answer: Depending on the area of the body, the time between each treatment will vary from 6 to 8 weeks. It is recommended to have 6-8 treatments to achieve maximum results.

Do I have to stop shaving before my laser hair removal treatment?

Answer: No, it is actually ideal to shave the area being treated immediately prior to your visit. The reason for this is to allow for the laser to bypass surface hair to better penetrate directly to the hair follicle.

What should I do between hair removal treatments?

Answer: You may shave the treated area only. You may not wax, tweeze, pluck, or bleach the hair between appointments. Shaving is the ONLY acceptable hair removal option for in between laser treatments.

For more information, call our office today at 610-896-6666 to set up a consultation with our aesthetician.

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Chemical Peels and Microdermabrasion

How much downtime can I expect from an in office chemical peel?

Answer: You can expect little to no downtime (including social downtime) with a chemical peel done in the office setting.

What are the major differences between a chemical peel and microdermabrasion?

Answer: A chemical peel chemically exfoliates the dead surface layer of the skin by way of application of chemicals directly onto the surface of the skin. A microdermabrasion is the physical exfoliation of the dead surface layer by use of a machine that incorporates mild suction and abrasion.

For more information, call our office today at 610-896-6666 to set up a consultation with our aesthetician.

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Rhinoplasty

When can I expect to return to my normal routine after a rhinoplasty (nose job)?

Answer: In general, it takes about two weeks to fully recover and return to work and/or school following a rhinoplasty. The time table can be more or less depending on the complexity of the surgery. Patients who just have their tips adjusted can expect a quicker recovery time than patients who require their nasal bones to be broken. It may, however, take up to 6 months until swelling has resolved and the final result is realized.

For more information, call our office today at 610-896-6666 to set up a consultation with Dr. Hoffman.

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Botox/Dysport

How long before Botox/Dysport results can be seen?

Answer: Botox and Dysport are both neuromuscular modulators. They cause blockage of the muscle receptors and weaken the strength of the muscles responsible for facial animation. The goal is to minimize muscle contractions and, therefore, decrease wrinkling during expression. Botox and Dysport can be used interchangeably. The main difference between the two is that Botox has a longer onset of action; it takes about 1 week to see results. Dysport usually takes about 3-4 days before results are able to be seen. Botox typically lasts about 3 months, but if used when animation begins to return, it can have a synergistic effect and last 3-6 months. Dysport usually lasts a little over 3 months and the same synergistic effect can be seen.

For more information, call our office today at 610-896-6666 to set up a consultation with Dr. Hoffman.

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Dermal Fillers

What is the recommended instruction regarding massage after Juvaderm or Restylane (filler) injections?

Answer: I typically recommend icing the area for twenty minutes at a time four times a day for the two days following facial filler injections. I also recommend gentle fingertip massage to the areas that have been injected. This helps even out the lumps/bumps that may occur during injection. These bumps will typically resolve on their own within a few weeks, but more quickly with gentle massage.

For more information, call our office today at 610-896-6666 to set up a consultation with Dr. Hoffman.

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Facelift

Should I stay in the hospital overnight after a Facelift?

Answer: Dr. Hoffman recommends that facelift patients stay overnight in the hospital or be monitored by a night nurse either at home or in a hotel for the first postoperative night following a facelift (rhytidectomy). Pain is not usually an issue after a facelift and will be controlled by oral pain medications. Preexisting medical conditions (such as high blood pressure) are more concerning and can cause postoperative complications such as hematoma formation or wound issues. Therefore, in these cases overnight monitoring is highly recommended.

Was there anything that I could have done to prevent jowls?

Answer: Premature aging can be caused by a combination of many factors. Stress and lifestyle are some of the main factors that contribute to aging. Genetics also influences how someone ages as well. It is always a goal to minimize stress and lead a healthy lifestyle as much as possible.

In order to improve the appearance of hanging or saggy jowls there are a few options. The more invasive of an option that you choose; the more results that you achieve. Non surgical options are fillers: which are injections of material that add volume to your face. They can be used to augment the lost volume of the midface and lift the jowls. Also, we perform Laser 360 in the office, which is a combination of laser and radiofrequency therapy that cause tightening and plumping of the face. This causes a lifting of the hanging jowls. Finally, a surgical option is a lower facelift. It lifts the tissues of the face and combined with fat injections elevates the jowls. During a consultation with Dr. Hoffman, you will be guided through these different options and see which one is the best choice for you.

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Liposuction / Brazilian Butt Lift

I want liposuction to improve my abdomen and lower back, and buttock areas?

Answer: Liposuction is a procedure that can be done under local (awake) or general anesthesia. It utilizes small incision to remove fat. Fluid that causes the tissues to swell and bleed less in injected through the incisions. It is called tumescent fluid. After the fluid is placed, a separate “straw” (cannula) is placed. It is a thin metal tube with holes at the tip. These holes remove the fat as the doctor passes the cannula back and forth.

Liposuction can be used to remove the fat and change the contour of an area. That is why sometimes you will hear it referred to as lipo-sculpting. It can cause some skin tightening, but not at the level that surgical excision of the skin can achieve. It also may leave some mild contour deformities or irregularities of the skin. Newer techniques such as S.A.F.E. liposuction, try to help limit these deformities. S.A.F.E liposuction is not safer than traditional liposuction, which is safe in experienced hands, but it is a technique to try to limit the irregularities after traditional liposuction and give superior results.

Some patients are taking the fat that has been removed from liposuction and placing it into different areas such as the breasts or buttocks. This is called fat grafting and it can be done in conjunction with liposuction.

Dr. Hoffman performs S.A.F.E liposuction both in the office and under general anesthesia.

Call our office to learn more during a consultation with Dr. Hoffman – (610) 896-6666

What is a Brazilian Butt lift?

Answer: A Brazilian Butt lift or a BBL is a procedure that takes fat from the surrounding areas of the buttock and places into the buttock to give a lift or improved appearance of the buttock. Fat can be taken from the stomach as well.

Liposuction is used to remove the fat, from the desired areas. It is then prepared and injected into the buttocks area to help augment the butt. By removing fat and then placing the fat a better contour and appearance of the buttocks is achieved. About 60 percent of the fat is able to survive and is permanent. It will grow and shrink as the patient gains and looses weight.

Dr. Hoffman performs Brazilian Butt Lifts in the operating room.

Call our office to learn more during a consultation with Dr. Hoffman – (610) 896-6666

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Mommy Makeover

I’m having a mommy makeover, will I be able to wear a bikini in 2 months?

Answer: A mommy makeover is commonly breast work (augmentation, reduction, or lift) in combination with a tummy tuck. Most early results are seen by 3 months. 2 months may be a little early to get into a bikini. Swelling and scarring are settling still at 2 months and you may not be completely bikini ready then. Some patients require more surgery and will require longer healing, other patients, have less surgery and can maybe pull off a bikini in 2 months. Talk with Dr. Hoffman and let him know you timetable and goals and we can work together to achieve them.

Call our office to learn more during a consultation with Dr. Hoffman – (610) 896-6666

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