The New Year is a great time to take inventory of your life-- and your beauty routine. Although there is no shortage of fads and gimmicks designed to make you look better, there are a few tried and true things that could help you make this year your most beautiful one yet.

Read my insider beauty tips-- as a woman, a plastic surgeon, and a beauty expert-- below.

1. Don't go to bed with your makeup on

Take it all off every night, no exceptions. Prolonged contact between makeup and your skin is comedogenic, pore-clogging, and acne-inspiring. Simply washing your face at night will go a long way in improving the quality of your complexion.

Image credit Wellnessinfo

2. If you are over 30, use a prescription-strength retinoid product.

This is the beauty secret of virtually every celebrity and model, and I consider it an essential component of a medical skincare routine. Retinoids give you smooth glowy skin, shrink your pores, and erase your wrinkles. If you are over 30 (or over 25 with sun damage or premature aging), I recommend retinoids for a beautiful complexion. My product line's Platinum Triple Glow (below) is powerful combination of tretinoin, hydroquinone, and hydrocortisone that will get rid of fine lines, even out pigment spots, and smooth your skin. I use this product every night before bed.

3. Don't get eyelash extensions or use false lashes.

These damage your delicate eyelash follicles and can cause alopecia (bald spots) where your eyelashes are supposed to be. Splurge on a great mascara, or use Latisse, or both, but avoid eyelash extensions at all costs.

Image credit visioninfo

4. Eat more leafy green vegetables.

Go ahead and buy that kale-spinach green juice. Studies show that not only do these vegetables give you much-needed vitamins and nutritional support, but they can also make your hair shinier, your nails stronger, and your skin healthier.

Kale, image credit Paddison Program

5. When you are having a terrible day, dress up.

Research suggests that it makes you feel good to look good. This powerful effect can be harnessed to get you out of a gloomy slump when you are having a tough day. Put on a great outfit, wear a splash of color, apply some makeup, or adorn yourself with a special piece of jewelry. The self-confidence boost will mitigate your difficult day.

Valentino Rockstud Heels, image credit GlitterInc

6. Resist the impulse to age your personal style.

Many women, as they get older, feel pressure to cut their hair, get highlights, wear heavy makeup, or put on a lot of jewelry. While it is certainly attractive to present yourself in an age-appropriate manner, these stylistic changes (particularly when taken all together) can age you. Consider avoiding some or all of these trends. Think of the ageless beauty Demi Moore-- long, dark hair, natural makeup, and minimal jewelry.

Demi Moore, image credit People

7. Wear a signature scent.

Olfaction is one of our most powerful human senses. Smell, after all, is neurologically tied to memory, pleasure, and the brain's reward pathways. Find a favorite scent (or several), and wear a small amount each day to stimulate this aspect of your brain and give you a boost of sensuality.

Chanel No. 5, image credit Vulkan Magazine

8. Know when to seek professional help.

Whether you want to color your gray hairs, whiten your teeth, try Botox for the first time, or explore plastic surgery, know when to seek the opinion of an expert. While there are countless sources of information out there-- not the least of which is the internet-- a trusted authority will apply his or her expertise to helping you analyze your situation and get your best results. You can buy a bottle of wine that costs $2 or one that costs $100, but which one do you actually want to drink?

Image credit Huffpo

9. THINK OF SUNSCREEN THE WAY YOU THINK OF BRUSHING YOUR TEETH.

You would never leave home without brushing your teeth, so don't leave home without applying sunscreen either. You don't see the results of sun damage overnight, but over the years, you will 100% notice a deterioration in your skin quality if you fail to protect your skin from UVA and UVB rays. I use Platinum SPF 45 Daily Tinted BB Cream from my own line every morning, rain or shine.

10. Remember the basics.

Don't forget all of the things your parents told you growing up: get enough sleep, eat balanced meals, get exercise, stick to a routine, think of other people's feelings, and spend time with your family and friends. These simple lessons will help you live a beautiful life. When you tap into beauty on the inside, you always reflect more beauty on the outside too.

Image credit Magic4walls

Happy 2016!

Actual patient of Dr. Devgan, before and 3 months after labiaplasty.

Labiaplasty is the fastest growing plastic surgery procedure in America, and it is also one of the most popular procedures in my New York City-based practice.

For a detailed explanation of the procedure, including information about surgical techniques and articles I have written as an invited expert on this topic, please read more on our dedicated Labiaplasty page:

Real labiaplasty results change over time. Right after surgery, you will notice an immediate improvement, although it takes months for all of the swelling to dissipate and reveal your final results. With each day and week that passes, your swelling will decrease and your appearance will improve.

Immediately after surgery, you will be able to go home. If you have surgery under local anesthesia only, you will feel fine within a few minutes. If you have surgery with sedation anesthesia, you will feel fine within 30 minutes. By 1-2 days after surgery, you can be back at work. By 3-4 weeks, you can be back to your normal exercises. By 6 weeks, you can resume sexual intercourse.

If you are interested in scheduling a consultation for labiaplasty surgery, please call my office at (212) 452-2400 or email info@LaraDevganMD.com. View some of my real patient results below.

Actual patient of Dr. Devgan, before and 1 week after labiaplasty.

Actual patient of Dr. Devgan, before and 1 week after labiaplasty.

Actual patient of Dr. Devgan, before and 1 week after labiaplasty.

Actual patient of Dr. Devgan, before and 3 months after labiaplasty.

Actual patient of Dr. Devgan, before and 3 months after labiaplasty.

Actual patient of Dr. Devgan, before and 3 months after labiaplasty.

We are pleased to announce that Dr. Devgan and colleague's novel approach to breast cancer reconstruction has been published in Plastic and Reconstructive Surgery Global Open Journal, the international open access journal of the American Society of Plastic Surgeons. Read the article below or via PRS Global Open.

Plast Reconstr Surg Glob Open. 2014 Aug; 2(8): e198.
Published online 2014 Sep 8. doi:  10.1097/GOX.0000000000000131
PMCID: PMC4236359

A Novel Technique of Preserving Internal Mammary Artery Perforators in Nipple Sparing Breast Reconstruction

Alexander Swistel, MD, Kevin Small, MD, Briar Dent, MD, Oriana Cohen, MD, Lara Devgan, MD, MPH, and Mia Talmor, MD

ABSTRACT

Summary:

As nipple-sparing mastectomy with implant-based reconstruction has increased, attention must be paid to the viability of the nipple-areolar complex. This article describes the use of preoperative Doppler ultrasound to identify the internal mammary artery perforators. Preserving the internal mammary artery improves vascular supply to the nipple-areolar complex.

Nipple-sparing mastectomy (NSM) with implant-based reconstruction (IBR) has gained in popularity.1,2Greater than 15% of nipple-areolar complex (NAC) loss is attributed to vascular compromise.3 Moreover, in patients who subsequently undergo IBR, NAC necrosis can lead to chronic open wounds, infection, implant exposure, and need for explantation.4–8

Blood supply of the breast stems from a deep and a superficial arterial system. The superficial system is composed of perforators from both lateral thoracic and internal mammary arteries.9 According to Palmer and Taylor,10 the internal mammary artery (IMA) contributes significant blood supply to the NAC. IMA perforators are superficial and can be identified using a handheld Doppler probe.9

Previous investigations have used Doppler ultrasound to identify major perforators to the NAC to increase nipple viability in reduction mammoplasty for gigantomastia.11 However, the application of Doppler ultrasound has not been applied to NSM with IBR.

In this study, we introduce a novel, easy, and inexpensive technique for improving NAC viability in NSM with IBR. Specifically, we employ preoperative Doppler ultrasound to identify IMA perforators to augment NAC perfusion.

PATIENTS AND METHODS

Patient Selection

With institutional review board approval, we retrospectively studied outcomes of a prospectively enrolled database of consecutive patients who received NSM with IBR in 2010–2012. Group A did not receive Doppler ultrasound and group B did. One oncologic surgeon (A.S.) and 1 plastic surgeon (M.T.) performed all procedures at Weill Cornell Medical Center. NSM was not offered if tumor size was greater than 2.5 cm or if tumor-to-nipple distance was less than 4 cm.12 NSM was not offered to patients with grade III ptosis or cup size greater than C. Outcomes were reviewed. Nipple ischemia ranged from epidermolysis to full-thickness necrosis; we applied the same grading system from our earlier works.13,14

Ultrasound Analysis

Patients were marked in a supine position with a handheld 8-MHz linear probe Doppler ultrasound (Siemens, Erlangen, Germany) by the oncologic surgeon. The probe was placed on the breast just lateral to the sternum and directed cranially to caudally, from the clavicle to the inferior costal margin. IMA perforators were identified on the skin surface (Fig. (Fig.11).

Surgical Technique

NSM was performed using a subdermal technique, as described in earlier works.13,14 IMA perforators corresponding to the Doppler mapping were identified and spared (Fig. (Fig.2).2). IBR was then performed, in 1-stage or 2-stage procedures, depending on patient and surgeon preference, as described in earlier works.13,14

This article was composed with the highest ethical standards and that the Institutional Review Board of Weill Medical College (New York, N.Y.) approved all study procedures in accordance with state and federal guidelines.

RESULTS

On hundred ninety-four NSM with IBR (117 patients) were reviewed in this series: 97 breasts (56 patients) did not receive Doppler ultrasound (group A) and 97 breasts (61 patients) did (group B). No patients were excluded from the database because of demographic factors, risk factors, oncologic burden, or postoperative results. When the ultrasound Doppler was used, all patients had identifiable IMA perforators, and the corresponding vasculature was visualized in flap dissection. There were no adverse events related to ultrasound. This clinical application added approximately 4 minutes to the surgical procedure. The results are summarized in Table able11.

This series demonstrated the use of Doppler ultrasound to define the vascular anatomy of mastectomy skin flaps; this study was not powered to correlate NAC ischemia with prespecified demographic criteria, comorbid conditions, or operative details. As such, no statistically significant relationship could be found between NAC ischemia and these endpoints. For example, for a 2-tailed Fisher’s exact test with n=97 in each group, and full-thickness NAC ischemia of 7.2% for group A and 10.3% for group B, and type I error of 0.05, the statistical power is low, 7.5%.

DISCUSSION

NAC ischemia after NSM occurs in 2.5%–60% of patients; rates vary significantly between institutions with respect to patient selection criteria, operative technique, and other factors.4–8 Previous investigators have reported surgical techniques to reduce the rate of NAC ischemia in NSM. In his series of NSM, Stolier et al15 discusses the importance of the incision to preserve sufficient inflow to the NAC. The most commonly employed incisions in NSM are inframammary, radial, and lateral.16–18 Colwell et al19 suggest that an inferior radial incision optimizes IMA exposure and nipple blood supply. In our experience, inframammary incisions provide superior cosmetic results and maintain adequate perfusion of the NAC.

Strategies for NSM preservation have been reported. Mastectomy flap thickness and sharp dissection with minimal use of electrocautery have been described.20 For high-risk nipple necrosis, surgeons have surgically delayed the NAC to maximize the viability of the nipple for a future NSM.1,21 Furthermore, preoperative patient selection of women with small, nonptotic breasts with limited comorbidities improves surgical aesthetic outcome for NSM.4–8 Also, adjunctive postoperative measures such as topical nitroglycerin paste have been useful.22

More advanced technologies that aid in the objective diagnosis of ischemia are currently in development, such as the SPY Elite System (LifeCell, Bridgewater and Branchburg, N.J.). For example, a study by Komorowska-Timek and Gurtner23 showed a significant decrease in ischemic complications from 15.1% to 4% (P < 0.01) after laser-assisted indocyanine green perfusion mapping was performed. Given the limited reports of SPY and the cost ($1000.00 with each screening and the fixed cost of the imaging device), we opted not to use this technique in our study.

Although Doppler ultrasound has been used to identify the vascular supply to the NAC in breast surgery,11our investigation uniquely reports its use with NSM and IBR; however, there are several limitations of this article. This investigation is a small case series designed to highlight a novel technique; this article is not powered to draw correlative conclusions about comorbid conditions or operative details, which may be expected to play a role in NAC ischemia.

CONCLUSIONS

Preoperative Doppler ultrasound of IMA perforators in NSM with IBR is a clinically useful adjunct to visualize perfusion of mastectomy skin flap to maximize nipple viability. In addition, this technique is easy, inexpensive, and rationally based.

ACKNOWLEDGMENTS

We would like to thank Dr. Andrew Weinstein of New York Presbyterian Hospital Plastic Surgery Division for statistical analysis.

Footnotes

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

REFERENCES

1. Gerber B, Krause A, Reimer T, et al. Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure. Ann Surg. 2003;238:120–127.[PMC free article] [PubMed]

2. Rusby JE, Kirstein LJ, Brachtel EF, et al. Nipple-sparing mastectomy: lessons from ex vivo procedures.Breast J. 2008;14:464–470. [PubMed]

3. Shestak KC, Gabriel A, Landecker A, et al. Assessment of long-term nipple projection: a comparison of three techniques. Plast Reconstr Surg. 2002;110:780–786. [PubMed]

4. Radovanovic Z, Radovanovic D, Golubovic A, et al. Early complications after nipple-sparing mastectomy and immediate breast reconstruction with silicone prosthesis: results of 214 procedures. Scand J Surg. 2010;99:115–118. [PubMed]

5. Algaithy ZK, Petit JY, Lohsiriwat V, et al. Nipple sparing mastectomy: can we predict the factors predisposing to necrosis? Eur J Surg Oncol. 2012;38:125–129. [PubMed]

6. Garwood ER, Moore D, Ewing C, et al. Total skin-sparing mastectomy: complications and local recurrence rates in 2 cohorts of patients. Ann Surg. 2009;249:26–32. [PubMed]

7. Komorowski AL, Zanini V, Regolo L, et al. Necrotic complications after nipple- and areola-sparing mastectomy. World J Surg. 2006;30:1410–1413. [PubMed]

8. Regolo L, Ballardini B, Gallarotti E, et al. Nipple sparing mastectomy: an innovative skin incision for an alternative approach. Breast. 2008;17:8–11. [PubMed]

9. Hall-Findlay EJ. Aesthetic Breast Surgery: Concepts and Techniques. St. Louis:: Quality Medical; 2011. Applied anatomy: key concepts for modern breast surgery. pp. 67–69.

10. Palmer JH, Taylor GI. The vascular territories of the anterior chest wall. Br J Plast Surg. 1986;39:287–299. [PubMed]

11. Basaran K, Ucar A, Guven E, et al. Ultrasonographically determined pedicled breast reduction in severe gigantomastia. Plast Reconstr Surg. 2011;128:252e–259e. [PubMed]

12. Vlajcic Z, Zic R, Stanec S, et al. Nipple-areola complex preservation: predictive factors of neoplastic nipple-areola complex invasion. Ann Plast Surg. 2005;55:240–244. [PubMed]

13. Dent BL, Small K, Swistel A, et al. Nipple-areolar complex ischemia after nipple-sparing mastectomy with immediate implant-based reconstruction: risk factors and the success of conservative treatment.Aesthet Surg J. 2014;34:560–570. [PubMed]

14. Huston TL, Small K, Swistel AJ, et al. Nipple-sparing mastectomy via an inframammary fold incision for patients with scarring from prior lumpectomy. Annals. 2014 In press. [PubMed]

15. Stolier AJ, Sullivan SK, Dellacroce FJ. Technical considerations in nipple-sparing mastectomy: 82 consecutive cases without necrosis. Ann Surg Oncol. 2008;15:1341–1347. [PubMed]

16. Sacchini V, Pinotti JA, Barros AC, et al. Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem? J Am Coll Surg. 2006;203:704–714. [PubMed]

17. Stanec Z, Zic R, Stanec S, et al. Skin-sparing mastectomy with nipple-areola conservation. Plast Reconstr Surg. 2003;111:496–498. [PubMed]

18. Woods JE. Subcutaneous mastectomy: current state of the art. Ann Plast Surg. 1983;11:541–550.[PubMed]

19. Colwell AS, Gadd M, Smith BL, et al. An inferolateral approach to nipple-sparing mastectomy: optimizing mastectomy and reconstruction. Ann Plast Surg. 2010;65:140–143. [PubMed]

20. Stolier AJ, Levine EA. Reducing the risk of nipple necrosis: technical observations in 340 nipple-sparing mastectomies. Breast J. 2013;19:173–179. [PubMed]

21. Jensen JA, Lin JH, Kapoor N, et al. Surgical delay of the nipple-areolar complex: a powerful technique to maximize nipple viability following nipple-sparing mastectomy. Ann Surg Oncol. 2012;19:3171–3176.[PubMed]

22. Kutun S, Ay AA, Ulucanlar H, et al. Is transdermal nitroglycerin application effective in preventing and healing flap ischaemia after modified radical mastectomy? S Afr J Surg. 2010;48:119–121. [PubMed]

23. Komorowska-Timek E, Gurtner GC. Intraoperative perfusion mapping with laser-assisted indocyanine green imaging can predict and prevent complications in immediate breast reconstruction. Plast Reconstr Surg. 2010;125:1065–1073. [PubMed]

Dr. Devgan is pleased to have been invited to participate in The Doctors, a nationally syndicated daytime television show on CBS, with a daily audience of 2 million viewers. Dr. Devgan was invited to speak about plastic surgery and surgical techniques for a special guest patient.

Actual patient of mine, before and just 2 weeks after upper and lower eyelid blepharoplasty

Actual patient of mine, before and just 2 weeks after upper and lower eyelid blepharoplasty. Close-up view

Tired-looking eyes are one of the most common complaints in my New York City plastic surgery practice.

AGING AROUND THE EYES

The skin around the eyes is the thinnest on the body, and it is the first place where you show your age. As early as the late 20s, crows feet or smile lines begin to etch themselves into the thin skin on the sides of the eyes. Dark circles and puffy bags under the eyes often come next, usually in the 30s. They are brought on not just by sleepless nights, professional stress, and the responsibility of childrearing, but also by the loss of elasticity in the skin. In the 30s and 40s, many people notice a hooding of the upper eyelids. In the 40s and beyond, extra skin folds accumulate on your eyelids and also underneath your eyes, making you appear more tired. A heavy groove begins to form between the bottom of your eye and your cheek (the "tear trough"). Makeup application becomes difficult. You look worn out and sad eyed, even when you feel energetic and happy. 

SURGERY: EYELID LIFT (BLEPHAROPLASTY)

The most definitive and satisfying way to make your eyes more youthful, beautiful, and energetic is eyelid surgery, or blepharoplasty. I consider blepharoplasty to be the gold standard for rejuvenating the eyes.

TEAR TROUGH FILLERS

In people with hollows underneath their eyes that make them look tired, I perform correction of deep tear troughs with fillers or fat transposition. My most popular procedure for this area is injection of Juvederm or Restylane in the tear troughs. This procedure takes minutes, has no downtime, and results can last for months to years. Tear trough fillers are best in patients who are younger with relatively good skin quality and minimal excess skin and fat.

CHEMICAL PEELS, LASER, BOTOX

In patients with younger tissue who require less, another great option is a chemical peel treatment to the skin around the eyes, as well as Botox to smooth out crows feet and smile lines. Both of these treatments also take just minutes. Downtime for Botox is minutes to hours, while chemical peels typically cause peeling of the skin 4-5 days after treatment.

This article was submitted by one of my mentees, Noelle Garbaccio, a high school student who is working toward a career in medicine. -Lara Devgan, MD, MPH

Social Media, Body Image & Plastic Surgery

By Noelle Garbaccio

With more than 300 million users sharing over 70 million images a day, Instagram has become a huge force in social media-- and in the hearts and minds of its participants. But do the beautiful, highly edited images we see on Instagram, Facebook, and other social media platforms reflect real life?

No, according to 19-year-old model and social media darling, Essena O’Neill. While Instagram and other photos may be gorgeous and visually appealing, they belie the reality of the human beings behind them.  Just as pictures in magazines are the products of incessant photo-shoots and Photoshop edits, so too are the pictures on social media.

Prior to deleting her social media accounts in early November, O’Neill edited the captions of her Instagram pictures to portray the truth behind the perfect photos. Several photos are shown below.

O’Neill’s captions demonstrate the effort expended for the photos idealized worldwide.  She admits that the best photos necessitated over 100 shots to capture, that her figure was achieved through skipped meals and excessive exercise, and that her most popular posts were highly edited and filtered.

While social media platforms are certainly aspirational, O’Neill’s exposure of the reality behind her attractive Instagram images is a reality check for anyone who regards them as inspiration for plastic surgery. A 2014 survey by RealSelf concluded that social media influenced up to 50% of users to consider cosmetic surgery—a concerning statistic, given that plastic surgery is not only a serious medical choice, but also a very personal decision.

If you are thinking about plastic surgery, it is important to understand that realistic expectations are at the heart of good results. While social media can provide inspiration or ideas, your individualized goals should be based on your unique characteristics, your personal desires, and your detailed conversation with your surgeon.

Hume, Kelly. "It's Time to Get Honest on Instagram." NewsComAu. N.p., 20 Nov. 2015. Web. 1 Dec. 2015. <http://www.news.com.au/lifestyle/sunday-style/opinion/its-time-to-get-honest-on-instagram/news-story/5ffdbd61709cb0c887d42947cc4518e6>.

Moss, Caroline. "'RealSelf' Is Like A Social Network For People Who Want Cosmetic Surgery." Business Insider. Business Insider, Inc, 10 Feb. 2014. Web. 20 Dec. 2015. <http://www.businessinsider.com/realself-for-cosmetic-surgery-2014-2>.

Olya, Gaby. "Essena O'Neill Admits to Skipping Meals and Exercising Obsessively to Feel Confident on Social Media." People Magazine. N.p., 16 Nov. 2015. Web. 02 Dec. 2015. <http://www.people.com/article/essena-oneill-skipped-meals-exercised-obsessively>.

Reiman, Patty. "Cosmetic Surgery and Social Media Influence in 2015." Dermatology Times. UBM Medica, LLC, 06 Jan. 2015. Web. 19 Dec. 2015. <http://dermatologytimes.modernmedicine.com/dermatology-times/news/cosmetic-surgery-and-social-media-influence-2015>.

Approximately 10-20% of women are born with inverted nipples, or nipples that are flat or sunken in appearance. For many women with inverted nipples, this is a source of self-consciousness that can effect body image, sexuality, and feelings of femininity.

Classification of Inverted Nipples

Inverted nipples are classified into three different groups, according to their severity.

• Grade I: Mildly inverted nipples that can be made to protrude with physical manipulation, cold temperature, or sensual stimulation. 
• Grade II: Moderately inverted nipples that can be made to protrude, but not easily. Women in this category often report difficulty breastfeeding.
• Grade III: Severely inverted nipples that cannot be made to protrude with physical manipulation. Women in this category are not able to breastfeed.

Correction of Inverted Nipples

The correction of inverted nipples is a short outpatient procedure that can be done with local anesthesia alone. Women experience minimal discomfort, typically take no pain medicine, and are generally able to return to work the following day. Strenuous exercise and tight fitting tops should be avoided for 2 weeks.

Surgical Limitations

Correction of inverted nipples is a very safe procedure with an excellent success rate in my hands. The plastic surgery literature reports that the most frequent complication of surgery is relapse of a corrected nipple, which is more likely if you have a more severely inverted nipple to begin with. Nipple necrosis is a rarely reported complication. It is also important to understand that breastfeeding is unlikely to be possible after correction of inverted nipples.

Next Steps

If you are interested in having your inverted nipples corrected in my New York City private practice, please feel free to call my office at (212) 452-2400 to schedule a consultation appointment. You may also email info@LaraDevganMD.com if you have further questions that you would like to have answered.

Actual patient of Dr. Devgan, before and 4 weeks after correction of broken nose (nasal fracture and laceration)

Actual patient of Dr. Devgan, before and 1 week after correction of broken nose (nasal and septal fractures)

Nasal fractures (broken noses) are among the most common facial injuries. Whether you are involved in a car accident, an accidental fall, a contact sport, or an altercation, breaking your nose is an incredibly common occurance in emergency rooms around the world.

There are three general approaches to the timing of when to fix your broken nose. In my New York City based practice, I use all three of these approaches, depending on the person and situation.

Approach #1: Immediately

If your nose is broken and you are most concerned about getting it back into correct anatomic alignment as quickly and efficiently as possible, fixing a nasal fracture right away may be a good option. Before massive swelling has set in, your plastic surgeon has the opportunity to numb your nose with a nerve block and use special instruments to replace the broken pieces where they are supposed to go. The advantage of this approach is its immediacy. The disadvantage is that it is slightly imprecise and may not be the best course of action if you are a model or actor.

Actual patient of Dr. Devgan, before and 1 week after correction of broken nose (nasal and septal fractures)

Actual patient of Dr. Devgan, before and 1 week after correction of broken nose (nasal and septal fractures)

Approach #2: At 1-2 weeks

Another option is to wait for the swelling in your nose to settle down a bit. Fixing a broken nose at 1-2 weeks is a good option because your bones have not yet set into the broken position, and your plastic surgeon will be able to fix their placement with a small surgical procedure. Fixing a broken nose in a delayed fashion will give you an excellent result, avoid swelling that makes acute fracture reductions more challenging, and get you back to normal relatively quickly.

Actual patient of Dr. Devgan, before and 1 week after correction of broken nose (nasal and septal fractures)

Actual patient of Dr. Devgan, before and 1 week after correction of broken nose (nasal and septal fractures)

Approach #3: After 6 months

If your main concern is having your nose look perfect, you may require a revision rhinoplasty 6 months after your broken nose. Even if the bones were re-set immediately or at 1-2 weeks, 6-12 months later, more of the swelling will have decreased, and your plastic surgeon will be able to reshape your nose in a more controlled fashion. If you are someone who makes a living with your facial appearance, or if you would like your nose to be more refined or perfect than it was before, this is an excellent option. 

For questions about nasal fractures, septal fractures, septal hematomae, rhinoplasty, revision rhinoplasty, or other nose surgery, I see new patients in my New York City office and in the emergency rooms of Lenox Hill Hospital and Greenwich Hospital. Please do not hesitate to email me at info@LaraDevganMD.com or call my office at 212-452-2400 if you have a broken nose and need help.

Fabian, Regula, 1982. Vimbai, Regula, Lukas, 1997. Fabian, 2014.

Photographer Barbara Davatz has produced a starkly beautiful portrait project spanning over 30 years entitled "As Time Goes By." In this project, which began in 1982, Davatz photographs the same subjects over the years, with children, partners (sometimes new ones), new clothing and hairstyles, and features that are recognizable yet slightly changed.

Her work has a simple and gorgeous documentary quality. These people are not just aging, they are living, and time is passing.

As a plastic surgeon who is concerned with issues of identity, beauty, aging, and evolution, this work was interesting for me to analyze and appreciate. Enjoy some samples of Davatz's work below, or purchase her beautiful book via Amazon.com below.

Bianca, Ernesto, 1982. Biana, Ernesto, 1997. Bianca, Carlo 2014.

Rico, Tiziana, 1982. Tiziana, Rico, 1988. Tiziana, 2014.

Carole, Serge, 1982. Carole, Serge, 1988. Serge, Carole, 2014.

Beni, Andi, 1982. Beni, Charlotte, Lou-Salomé, Natalie, 2014. Andrea, Anna, Leila, Andi, 2014.

Surgical specimen from an actual labiaplasty case by Dr. Devgan

Labiaplasty is one of the most commonly performed operations in my New York City plastic surgery practice. As a female plastic surgeon who is board-certified, trained at some of the world's preeminent institutions, and experienced in labiaplasty techniques, many patients seek me out for this delicate procedure.

One common question I am asked is whether a patients should have surgery with IV sedation ("twilight" anesthesia) or wide awake with local anesthesia only. My answer is that both options are great. Read more about a recent patient's experience with local anesthesia only during her labiaplasty procedure, below.

Verified patient review from RateMDs.com

Actual patient of Dr. Devgan, before and after submental liposuction

Submental liposuction (or microliposculpture of the double-chin area) is one of the most popular aspects of my New York City plastic surgery private practice. While submental liposuction is a powerful procedure with an extremely high degree of patient satisfaction, it is also a complex topic. This was an invited article for online physician magazine Healio.com about the ins and outs of submental liposuction. The intended audience is medically oriented, so some portions of this article are more technical. -Dr. Devgan

Submental Liposuction: A powerful technique for sculpting the lower face

By Dr. Lara Devgan

How the face changes as we age

The young, slim face has a characteristic "inverted cone of youth"-- a triangular shape like that is narrow at the chin and wider at the cheeks.

As we age, gain weight, develop unfavorable patterns of fat deposition, and experience tissue laxity setting in, this cone becomes more of a square. The jawline becomes thicker and less distinct, a double-chin develops, and jowling becomes more apparent.

Traditional methods for addressing facial aging

Although facelift and necklift are considered the gold standard procedures for addressing facial aging as a whole, younger patients and patients who would like to have a quicker recovery with fewer incisions tend to shy away from these procedures. For this subpopulation, submental liposuction is an excellent option.

Submental liposuction

Submental liposuction, or microliposculpture of the area under the chin, is a minimally invasive contouring procedure for the lower face. Using one to three tiny 0.5 cm incisions placed in inconspicuous locations, an experienced plastic surgeon is able to refine and define the lower face.

Patient selection and technical considerations

The critical first step in submental liposuction is analyzing the patient. The best candidates for the procedure are those with excess pre-platysmal fat, a "double-chin," or the appearance of a heavy, square-shaped, bottom-heavy face. For those with platysmal banding, excessively thin skin, inelastic tissue, or minimal fat in this area, submental liposuction may not be as effective an option.

Marking

Once I have determined that a patient is a good candidate for the procedure, I mark the patient in a seated position while he or she holds a hand mirror to actively participate in the process. Problematic or bothersome pockets of fat are identified and circled. I also take a moment to mark the planned incision sites (0.5cm stab incisions at the submental crease and in the post-auricular sulcus bilaterally. Finally, I mark the angle of the mandible and the presumed course of the marginal mandibular nerve bilaterally.

Anesthesia

Submental liposuction can be done wide awake with tumescent local anesthesia only, or with IV sedation. For patients who are combining submental liposuction with another procedure (such as blepharoplasty-- a common pairing), I recommend IV sedation, or twilight anesthesia. For healthy patients who are comfortable with the idea of surgery, being awake is an acceptable option.

Surgical technique

After sterilely prepping and draping the patient, I infiltrate 50-100cc of tumescent solution composed of 1% lidocaine, 1 ampule of epi, and 1 liter of lactated ringers into the subcutaneous tissue of the neck. I let the tumescent solution sit for 5 to 7 minutes so that the vasoconstrictive effects of the epinephrine can take effect.

Next, I incise the previously marked liposuction access sites and dissect them open with iris scissors. At this point, I perform judicious liposuction of the preplatysmal fat according to my previously noted markings.

When performing liposuction of the neck area, it is important to use fine-tipped cannulae that are in a sufficiently deep plane so as not to create contour abnormalities or divets. I am also careful to liposuction in a cross-hatched pattern to ensure a smooth and aesthetically pleasing result. Liposuction is performed from one to three of the aforementioned access sites; using three sites is ideal because of the lower risk of creating contour problems.

Pitfalls and Complications

The most common complication of submental liposuction is contour abnormality, including notching, divets, and irregular appearance of the skin. This can be avoided by carefully performing liposuction according to the principles of ideal liposuction techniques.

Another complication is injury to the surrounding structures of the neck, in particular, the marginal mandibular branch of the facial nerve, as well as nearby arteries and veins. This is avoided by thorough anatomic knowledge of this challenging anatomic area.

Alternatives

The two major alternatives to submental liposuction are Kybella and necklift.

Kybella (deoxycholic acid) is a new injectable medication that will dissolve submental fat after several treatments. While Kybella has the advantage of offering no downtime at all, this treatment can take several sessions. In addition, patients experience profound swelling that can last for weeks. 

Necklift (including short-scar necklift) is a surgical technique that involves tightening the platysma, SMAS, and substructure of the face and facial skin. This is an extremely effective technique for rejuvenating the under-the-chin area, and I consider it to be the gold standard treatment. The downside of necklift is the fact that it is major surgery that requires a week of downtime from work.

Submental liposuction is an excellent intermediate option, between Kybella and necklift, and it carries with it many benefits from both sides.

For questions about this article, I can be reached via www.LaraDevganMD.com.

Click to read this article on Healio.com

According to plastic surgery principles, the base of the nose should be no wider than the distance between the eyes (the intercanthal distance).

Rhinoplasty, or "nose job" surgery is one of the most common plastic surgery procedures worldwide. Whether you were born with a nose that doesn't suit your facial features or your nose has grown or changed over time (sometimes from a previous broken nose), rhinoplasty is a powerful technique for re-proportioning your facial features. A well-done rhinoplasty is noticeable only in the sense that your face has greater aesthetic harmony, and your eyes, cheekbones, and smile are more noticeable.

A special type of rhinoplasty that I perform in my New York City private practice is called Alar Base Reduction. This is a surgical technique for narrowing a wide nose and reducing the flare of the nostrils. 

Surgical planning

Alar base reduction involves excising the excess portion of the nostril base in order to bring the nostril into a more pleasing, narrow shape.

When planning an alar base reduction procedure, I perform a detailed physical examination, look inside and outside your nose, and take preoperative photographs that are precisely measured in order to account for a number of factors:

1. the shape of your nose
2. the flare of your nostrils at rest and while moving
3. the proportion of your nose as compared to the space between your eyes (the distance between the medial canthii)
4. the overall harmony of your facial features
5. the strength of your nasal cartilages
6. the thickness of your nasal skin
7. your cultural or ethnic background
8. and most importantly, your desires for how you will look after surgery

Surgical technique

Surgical specimens from an alar base reduction rhinoplasty done by Dr. Lara Devgan, New York City based board-certified plastic surgeon.

Alar base reduction is done to make the nose appear more refined, defined, and narrow at its base. Alar base reduction (sometimes called Weir excision rhinoplasty or Weir excisions) is a short procedure that can be done in 30-60 minutes, with local anesthesia only, while you are awake and pain-free. All incisions are planned to be hidden and camouflaged.

Recovery

After alar base reduction rhinoplasty, you will be able to return to work or school the next day. Many people choose to take a week off if they want to keep their surgery from their friends and colleagues, but this is not required from a pain or medical standpoint. You will use ice for comfort and swelling in the first few days following surgery, and you may take Tylenol for pain. Approximately one week after surgery, your stitches will be removed.

Next Steps

If you are interested in Weir excisions or surgery to make your nose narrower, please do not hesitate to reach out to my practice via email (info@LaraDevganMD.com) or phone (212-452-2400). We will help you set up an in-person consultation in order to plan the best approach to help you achieve your goals.

I was honored to appear on The Doctors, on CBS nationwide on February 11, 2016.

In this special episode, the audience met a brave, beautiful woman who suffered burns on over 85% of her body when her jilted ex-boyfriend set her house on fire. Miraculously, she not only survived, but she has become a powerful role model for others who suffer from domestic violence.

As a result of her devastating burns, she has severe disfigurement of her face and hands that will require extensive plastic surgery.

I was honored to be asked by The Doctors TV to participate in her care as her reconstructive plastic surgeon. Not only is this one of the most challenging cases of my career, but this patient is also one of the most profoundly moving women I have ever met. During taping, her story brought the studio audience to tears and inspired a minutes-long standing ovation. I encourage all of you to see how even the most horrific circumstances can be turned around in this uplifting story, which can be viewed online below. 

Part 1: Woman Set on Fire by Jealous Ex; click to view segment

Part 2: Woman Survives Being Burned by a Jealous Ex; click to view segment

Part 3: Woman Burned by Jealous Ex Seeks Help from Dr. Lara Devgan; click to view segment

Part 4: Help for a Woman Burned by her Jealous Ex, donated by Dr. Lara Devgan; click to view segment

Dr. Devgan is pleased to have been named a Verified Beauty and Wellness Expert for the renowned aesthetic health and wellness guide, Charlotte's Book. Inclusion in Charlotte's Book is by invitation only. Charlotte's Book experts adhere to strict professional and ethical standards that go above and beyond board-certification by the American Board of Plastic Surgery (which is, of course, a prerequisite). 

Click to view Dr. Lara Devgan's listing in Charlotte's Book as a preferred expert plastic surgeon in New York City

Dr. Devgan was honored to be named one of the top cosmetic doctors in the US in 2015 by RealSelf in the 2015 RealSelf 500 list.

Click to view the full list of the RealSelf 500 for 2015

This ran as an invited article for The Doctor Blog by ZocDoc on February 24, 2016.

I’m a Plastic Surgeon and a Woman. Here’s What Beauty Standards Mean to Me

February 24, 2016 By Lara Devgan, MD

When I introduce myself as a plastic surgeon, I am often greeted with surprise. Between the slightly quizzical looks, the concerned head tilts, and the explicit queries, the question is clear: How could a woman of substance find herself in that line of work?

The truth is that real plastic surgery (in my world, at least) is nothing like its media representations. The nipped and tucked patients with outlandish requests, the salacious and provocative doctors, the ostentatious displays of wealth and consumption – these have nothing to do with my life or career. Plastic surgery, at its core, is an academic discipline that requires more than a decade of intense study, anatomic mastery of the entire human body, and precision surgical skills that are fine enough to sew a one millimeter blood vessel and strong enough to put the abdominal muscles back together. My patients are real, relatable human beings who have concerns about their physical appearances.

When I plan my surgical cases – whether they are reconstructive operations for breast cancer or broken facial bones, or cosmetic operations for facelifts or breast implants – I go through the same rigorous procedure. I examine, photograph, measure, and map out my incisions and approach. I review the patient’s medical history, prior surgeries, allergies, family history, and relevant habits. I consult with internists, anesthesiologists, radiologists, and hematologists to make sure each patient is optimized for surgery. Finally, I carry out the operation with attention to the highest standards of safety and quality. Plastic surgery, from the surgeon’s standpoint at least, is a serious intellectual field with a heavy dose of art and science.

Although a significant portion of plastic surgery procedures are reconstructive (for cancer, burns, injuries, and congenital anomalies), the majority of my practice is devoted to cosmetic surgery. And as a woman, wife, mother, expert in aesthetics, and board-certified plastic surgeon, I make no apologies for that fact.

Real, complex, intelligent women and men care about their appearances. It is part of the human condition to want to present yourself in the best way you can. There is no shame in wearing makeup, getting your gray hair colored, buying fashionable clothes, or working on your abs, and there should be no shame in getting plastic surgery either.

Elle magazine writer Elissa Strauss tackled this subject in an article she penned for Elle.com last year: “The way we talk about women who get plastic surgery is based on the assumption that caring about our looks and caring about our souls is a zero sum game,” she wrote. But the truth is that “[w]e are more than capable of searching for internal truths with lipstick on, being feminists with face lifts, or choosing something a little fake while also being very real.”

The beauty standards that are so prevalent in our modern zeitgeist are not abhorrent simply because they exist, but because they exist against a notion of effortlessness. You must be born beautiful, wrinkle-free, with a taut abdomen, a perfect nose, full lips, and the spoils of the genetic lottery, or else you are a superficial “plastic surgery junkie.” This concept that there is no solution to having something about yourself that you dislike is limiting, disheartening, and false.

The reality of plastic surgery is that it can be an incredibly empowering way to harness artistry and technology to help people feel better about themselves. It is this part of my job that I enjoy the most. You can be a brilliant lawyer and want larger breasts. You can be a successful businessman who dislikes his nose. And you can be a woman of substance and also be a plastic surgeon. I have a wall of diplomas and thousands of patients to prove it.

Click to read this article on ZocDoc's Doctor Blog

Labiaplasty is one of the most popular procedures in my New York City practice. Many women have questions about what it will be like immediately after surgery.

Immediately after surgery, there is no pain and only minimal swelling. The majority of your discomfort will start several hours after the surgery and will occur in the first 1-2 days. Most patients do very well with ice packs, Tylenol, and sometimes stronger pain medicine.

Swelling peaks at about 2-3 days after surgery and continues to get better over the course of the next several weeks. By 1 month, you will have 80-90% of your final surgical result. A tiny amount of swelling will continue to go away over the course of the next few months. You will be able to resume exercise at 4 weeks and sex at 6 weeks.

For questions or to book an appointment, please email info@LaraDevganMD.com or call 212-452-2400.

The images above show an actual patient of mine before, 5 minutes after, 1 week after, and 1 month after labiaplasty surgery.

Image credit Shutterstock/ Prevention.com

Dr. Devgan was recently interviewed for Prevention Magazine. This piece ran on February 26, 2016 on prevention.com. An excerpt of the article is below:

6 Crazy Things Plastic Surgeons Have Seen

FEBRUARY 26, 2016

By KATE BAYLESS

It's not all minor lifts and subtle tucks: With more than 15.6 million plastic surgeries performed last year, there are bound to be some unusual requests along the way. We spoke with plastic surgeons from coast to coast to get the scoop on the strangest, oddest, and downright craziest requests they've gotten from patients...

What Not to Expect When You're Expecting

Though pregnancy often brings a fuller bust, for one woman it wasn't enough. "I was once asked to place breast implants in a pregnant woman," shares Lara Devgan, MD, of New York City. "That is definitely not within the standard of care. You can't do elective plastic surgery during pregnancy."

Click to read the full article via Prevention Magazine

Dr. Devgan was honored to be featured in Avenue Magazine's special March 2016 issue dedicated to Age Defiers & Beauty Innovators. Her interview with the magazine is pictured below.

An actual patient of mine, pictured before (left), 1 month after (middle), and 3 months after (right) breast augmentation with silicone implants in the submuscular dual plane.

Although breast augmentation gives you an immediate boost in your breast volume and fullness, the final position of breast implants is not fully visible until approximately 3-6 months after surgery.

Aside from extenuating circumstances, I prefer to perform the vast majority of my breast augmentation operations with the implants placed under the pectoralis major (chest) muscles. This is called submuscular or dual plane placement. Not only does submuscular implant placement have a lower risk of rippling, implant visibility, and infection, but it also makes the breast implants look more natural and age better over time.

One consequence of submuscular (dual plane) breast implant placement is that the breast implants take a bit of time to migrate into their ultimate anatomic position.

Immediately after surgery, it is common for the breast implants to be high up on the chest wall and feel a bit firm. As weeks and months progress, they "drop and settle" into a nice, natural, teardrop shape with a soft, supple feel. By one month, you will have about 60% of your final look, by 3 months it is about 90%, and by 6 months, you should be there.

For questions about breast augmentation with beautiful, natural-looking results, please call my New York City plastic surgery office at 212-452-2400 or email info@LaraDevganMD.com.