Surgeon chats with readers about cosmetic procedures

January 9, 2008

This chat has already taken place. Read the transcript below.

Scott Thellman

Dr. Scott Thellman of Lawrence Plastic Surgery chats with readers about cosmetic procedures and how the industry is changing in the Midwest.


Good afternoon. This is Dennis Anderson, managing editor of the Lawrence Journal-World. Our guest today is Dr. Scott Thellman of Lawrence Plastic Surgery. He will be answering your questions about cosmetic surgery. Welcome, doctor.

Scott Thellman:

Thanks for setting up this chat! I type poorly, but I'll do my best.


We have several questions, so let's just jump right in.


I am interested in the chemical peel, can you tell me how much the treatment costs and how many treatments are needed? Who are the ideal candidates?

Scott Thellman:

We do the light to moderate depth peels in our office. The cost is around $100 (I think). It's best for treating fine wrinkles, pigmentation irregularities, and improving the overall appearance of the skin. I don;t think we achieve significant improvement with really deep wrinkles. We usually have to try the laser or other means to treat more damaged or aged skin. Usually we suggest 3-6 treatments.


I'm a young woman who has suffered from acne for most of my life, and it has left me with some mild scarring. What kind of procedures do you recommend for reducing acne scars?

Scott Thellman:

I think acne scars are one of the toughest conditions to treat. I've used chem peels, microdrmabrasion, IPL, and laser resurfacing all with only moderate results. I wish I had a better treatment, and I'm still looking for the answer. I think we can achieve only a modest improvement at best. The treatments out there, whether high tech or low tech, never seem to live up to the promise of making these scars disappear. Start easy and low risk (chem peels, microderm), then work into other treatments (laser) if necessary.


I am interested at the end of this year in getting breast implants and a "tummy tuck" (without liposuction). Is it possible for a surgeon to place breast implants through the incision that will be made in my abdomen to eliminate excess skin from pregnancy?

How much should I expect to pay for such a surgery performed by a good, reputable surgeon?

Also, I've researched breast implant surgery where the surgeon places the implant through a small incision in the armpit. Is recovery time for this type of breast implant surgery significantly less than more conventional surgeries?

Scott Thellman:

I have seen the procedure of placing the implants through the abdominoplasty incision described, but have not done it myself. Personally, I think that it would make precise placement of the implants more difficult, as a good breast augmentation requires precise development of the pocket that will hold the implant. As for the armpit incision, I've done it that way a few times in the past, but I'm not a big fan of this approach. It puts a scar where potentially it could be seen in a sleeveless dress or swimsuit if the arm is raised. Honestly, it's a rare patient that has a significant scar from an implant placed through the areola or under the breast. Talk to patients who have had it done. As far as cost, I expect it might be in the 10-15000 range for everything.


I am in my 50s and was interested in a bust enhancement and lift. What is the average cost and will sensitiveness be affected?

Scott Thellman:

This is a commonly requested procedure. It generally runs around $8000 for everything (surgeon, implants, anesthesia, OR, etc.) While some decrease sensation of the nipples always occurs temporarily, permanent numbness (although a potential risk) is unusual.


If an individual has had a breast augmentation, what does it mean when the nurse states that an implant may have formed its own capsule? What is the solution to this problem? How do you diagnosis this condition?

Scott Thellman:

A collagen capsule ALWAYS forms around an implant within a few weeks of placement. This is a normal response and is not a problem Occasionally, the capsule will thicken and contract, essentially forming a scar arounk the implant. This was much more common with some of the older silicone implants placed back in the 80's. We don't see it as often now. If the implant is abnormally firm, it is not dangerous but can disturb the look and feel of the breast. Reoperation may be required to divide or remove the capsule if it does not resolve with massage.


Which procedures are considered the most risky in terms of complications during/after surgery and why?

Scott Thellman:

The riskiest tend to be the major body contouring procedures such as a lower body lift. The operations may be long, several pounds of tissue may be removed, and post operative pain more significant. We always keep these patients overnight for observation and monitoring after surgery, sometimes longer(2-3 days in the hospital). If we feel the risk is too great, we'll suggest the patient simply not do the procedure.


Can solar keratosis be removed in one try with a laser procedure?

Scott Thellman:

Yes, there are several types of lasers out there that can do this. However, if your skin is prone to these, you will probably eventually grow new ones.


How can I compare what I am receiving for my money when purchasing Botox treatment.
Is there a standard volume in grams for 1 syringe or other way I can ensure what I'm getting. Also how do I know the material is fresh I was told by one doctor this is an important consideration. Also, each doctor administers a different amount of injections to treat the area on my forehead above the bridge of my nose - is there a correct number for effectiveness?

Scott Thellman:

Botox is measured in units. How much volume is injected, or how much is in a syringe, varies depending on how it is mixed by the doctor or nurse. Feel free to ask your doctor how much they are injecting (units) and they'll be glad to tell you. The response you get varies from patient to patient. The standard treatment for the area you describe is about 20 units, but I've had to use double this amount in some patients to get a response. Like any drug, the amount it akes to get an effect varies with individuals.


Can you explain the difference between silicone and saline implants? Is one used more than the other?

Scott Thellman:

Big question. Got a few hours for an answer? I'll give you the short answer. Silicone implants have a softer and more natural feel than saline implants. If they leak (which is possible with any implant over a long period of time), the saline implants are easier to replace. I think good results can be achieved with either type. The patients where the difference in the final feel of the implant is most noticeable are those with very little breast tissue to begin with, or none at all (mastectomy patients). We've been using silicone implants under study conditions on some of our mastectomy patients for the last 5-10 years. Since they became available for general cosmetic use, the majority of our patients are choosing silicone for cosmetic augmentation.


I have been considering a breast reduction for several years, but I am concerned about scarring since I have had some keloid tissue develop in the past. I am also wondering about the cost.

Scott Thellman:

Scarring is definitely going to occur with this operation. We show patients before and after photos of patients so they will understand exactly where the scars will be placed, and how they might look afterwards. However, I would suggest you talk to others who have undergone the operation. Most will tell you that their symptoms of back and neck pain are greatly improved, they feel better, they look better in clothes or a swimsuit, and the scars are an acceptable trade for all these benefits. Most reduction patients would be happy to show you their scars. The operation costs around $7000 but may be covered by insurance if your symptoms are significant. I think this operation probably has the highest satisfaction rate of any that we do, mainly because we improve significant physical symptoms and appearance at the same time.


We are out of time for this chat. Unfortunately, we couldn't get to everyone's questions this afternoon. I want to thank Dr. Thellman for joining us, and the readers for their questions.

Scott Thellman:

Thanks for hosting this, Dennis. I could answer questions like this all day but I've reached my limit on typing. I'm worn out! We didn't get to everyone, but call our office and talk with one of the staff or myself. We may be able to answer your questions over the phone.


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