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    Learn more about Dr. Bermudez and the services offered at our practice by reading through testimonials written by current and former patients.

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    Kenneth Bermudez, MD, is a board-certified plastic surgeon with more than 20 years of experience. He is committed to helping his San Francisco cosmetic and reconstructive surgery patients achieve — and often exceed — their cosmetic goals.

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    Dr. Bermudez has been honored numerous times for his surgical excellence. Most recently, he was selected as the Best San Francisco Plastic Surgeon by Marin Magazine for 2013.

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Monthly Archives: January 2013

Breast surgery and pregnancy. Should I stay or should I go?

I think most plastic surgeon’s agreed that you should wait to have breast aesthetic surgery if you are considering having children in the near future. Additional pregnancy with will continue to affect the appearance of her breasts and possibly cause more sagging and loss of volume. Additionally, breast surgery can affect your ability to breast feed and therefore, it is more prudent to wait until your finished having children. Many times, women who have had multiple pregnancies will also have excess skin and loose abdominal muscles (rectus diastases) which will also need to be addressed after they had completed all of their pregnancies. Many times both the breast and abdominal surgery can be done at the same time. Good luck.

Scars and eyelid surgery

While all surgical operations involve some type of scar being placed, blepharoplasty is probably one of the least noticeable scars in plastic surgery. This is multifactorial. One, the location of the scars for upper blepharoplasty (upper eyelid surgery) is placed in the crease of your upper eyelids make them less noticeable. Additionally, the blood supply to the eyelids and the thinness of the skin make healing quick and scarring minimal. Every plastic surgeon has his regimen on how to manage your scars postoperatively which would minimize significant scarring. Listen very carefully and follow instructions to maximize your result. For the lower eyelids, there are a few options. Standard lower eyelid (lower blepharoplasty) procedure involves an incision just below the lower eyelashes which extends laterally along the orbit. A transconjunctival blepharoplasty places the incision inside the lower eyelid. Laser resurfacing treatments can be used to resurface the skin with the transconjunctival blepharoplasty which will help tighten moderately loose skin. This will avoid an incision externally but can only be done in patients with minimal to moderate skin excess along the lower eyelids. I hope this helps. Good luck.

What implants are available in the United States?

In the United States, both saline and silicone implants are available for use in primary breast augmentation. They are approved by the FDA. There are restrictions in using silicone  implants in young women. They must be 22 y/o for primary breast augmentation. A recent study highlighted preferences for silicone implants and patient's choosing to undergo primary breast augmentation. This has been my experience as well. Most women like the feel of the silicone implants despite the difficulty with diagnosing problems with leaks or ruptures. The 2 largest breast implant manufacturers are Mentor and Inamed (a division of Allergan). Both have excellent safety profiles and make a good product. Your board certified plastic surgeon should be able to tell you which implant will best fit your needs. Good luck.

I have an ugly mole, please remove it!!!

There are several options for removing a mole (laser, shaving, and cutting). Given that raised moles can grow deeper than just the surface of the skin, I would suggest excising the entire mole via cutting method (best way to ensure all mole cells are removed above and beneath the skin so you won’t see the mole grow back again!) During mole removal, I will mark the area around the mole to be removed in the shape of an ellipse (oval), and then numb the area around the mole with local anesthetic. After the anesthetic kicks in, I will use a scalpel to cut around the mole (elliptical excision), cut out the rest of the mole beneath the skin and cauterize (or burn) the area to prevent excess bleeding. The area is cleaned, sutured, and steristrips are placed over stitches to keep them clean and safe.

Fat Transfer

I will be attending the Miami Fat Graft Course with Dr Khouri in February. I hope to be able to deliver new reconstructive techniques to both my breast cancer reconstruction and aesthetic patients. Fat grafting is a relatively simple idea: harvest fat cells from your own body (autograft) and use these same fat cells as filler where needed (the face, for example).  The procedure is not too difficult, and takes only a few hours.  Under local anesthesia, your doctor will remove these fat cells with a specialized syringe from either the abdomen, thighs, or buttocks. Next, your doctor must isolate the harvested fat cells from the other fluids that were initially collected from the harvest site by centrifuging (spinning very quickly) the collected tissue. The doctor can now use the isolated fat cells to inject them under the facial skin, for instance, into areas where filler is needed.   One main issue you should take into account when considering fat grafting is the high incidence of reabsorption of the fat cells back into the body and out of the specific areas where filler is needed, leaving you with poorer results than expected. With so much attention being paid to fat grafting, our hope is that the improved harvest techniques will improve outcomes.  

How Long Does Perlane Last? Cost?

Perlane is made of hyaluronic acid; just like Restylane and Juvederm. It is thicker than Restylane, so it is best for treating the nasolabial folds.  The manufacturer recommends anywhere from 4.5 months to 9 months for follow-up treatments. We have also noticed that patients who followed the treatment regimen regularly, they are seeing the results lasting up to 18 months. In San Francisco, we charge $600 for a 1cc syringe of Perlane. The amount of Perlane needed varies from patient to patient. In some cases, more than one syringe is needed to achieve optimal results.

Botox Units vs Cost

Almost every week I get questions from my patients regarding BOTOX cost. The costs are determined by the amount of unit given a specific area. The larger the area or the stronger the muscles, the more units are needed driving up costs. There are multiple scientific papers with recommendations to how many units are required per area. Patients who have a considerably lower price per unit should be wary. They may not be getting what they paid for... Most importantly, I would advise you to go to a plastic surgeon who does this regularly. Hope this helps.

Does Dysport last longer than Botox?

These prescription injection medications, Dysport and Botox, are used to treat fine facial wrinkles . They are very similar, with only subtle differences between the 2. Most plastic surgeons would agree that they last about the same time (4 months). Historically, Botox has been used since the mid 90s to treat cosmetic facial wrinkles. Dysport was recently introduced in the United States (2 years) for similar indications, but it has been used in Europe for nearly 10 years. In my practice, Dysport has a quicker onset of action, but we have not noticed a significant difference in the longevity of the product. Some of my patients have claimed that the Dysport last longer when they compared to their previous Botox injections. This is purely anecdotal and to my knowledge hasn't been proven in a well designed study. Hope this helps. Good luck.

Eyelid Surgery Risks

List of possible complications: Abnormal lid position Abnormal scarring Abnormal skin color Anesthesia reaction Bleeding Blindness Blurred vision Burning Corneal abrasion Double vision Decreased sensation in eyelid Difficulty closing eyes Dry eye syndrome Excessive tearing Gritty sensation in eye Inability to close eyes Milia Reactions to medications Retrobulbar hematoma Slow healing Stinging Visible scarring Complications of eyelid surgery, while rare, can cause prolonged healing, change in or loss of vision, unpleasant-appearing and painful scars, the inconvenience and cost of further surgery, and the possibility of requiring eye drops or ointment, temporarily or permanently. Blindness The risk of permanent blindness is less than 1 out of 10,000. Vision loss is usually related to bleeding following eyelid fat removal. Blurred vision This is a temporary condition that occurs in less than 1% of surgeries. Corneal abrasion This condition is temporary and is easily treated by patching the eye for 1-3 days. Double vision This condition is temporary and occurs in less than 1% of surgeries. Difficulty closing eyes This condition is usually temporary in rare cases. In rare cases, corrective surgery is required. Dry eye syndrome Dry eye syndrome is potentially dangerous. In rare cases it leads to damage to the cornea of the eye and vision loss. Inability to close eyes This condition is usually temporary. In rare cases, corrective surgery is required. Milia Tiny skin cysts can form on the scar line. This is normally temporary, but in some cases requires surgical removal. Retrobulbar hematoma A rare complication in which a pocket of blood forms behind the eyeball.

How much does a blepharoplasty cost? Are the prices different for blepharoplasty on the upper eyelids vs. the lower eyelids?

The price for blepharoplasty varies depending on the location, the doctor’s expertise, and the amount of work that needs to be done. Generally, the surgeon’s fees range from $3,000 to $5,000.00 and there will also be additional costs for the operating room and general anesthesia if needed. In most instances these surgeries can be done under sedation, without general anesthesia. Hope this helps, good luck.