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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: February 2013

FDA Approves New Silicone Gel Breast Implant.

On February 20, 2013, the FDA approved the Natrelle 410 highly cohesive anatomically shaped silicone implant.  Candidates for implantation must be at least 22 years of age or have undergone reconstruction after treatment for breast cancer. The new Natrelle 410 implants containing more cross-linking compared to silicone gel used in other implants.  The increased cross-linking results in a silicone that is firmer.  Although these the new implants may not be appropriate for all patients, it’s nice to have additional options to give the consumer a broader choice. The FDA has based its approval on a study of over 941 women who received the implants and followed them over 7 years.  Most complications and outcomes were similar to those found in previous breast implant studies including capsular contracture, reoperation, asymmetry, implant removal and infection.  In addition, investigators found fissures or cracks in some of the Natrelle 410 implants.  This "gel fracture," as it is referred to, is unique to this implant. I always remind patient’s that breast implants are not lifetime devices. I counseled my patients the patient fully understand the risks associated with breast implants before considering augmentation or reconstruction surgery. Long-term monitoring of these and all implants is essential. If you are thinking about breast reconstruction or breast augmentation, please do not hesitate to contact our office for consultation. I hope this new information helps.

It’s winter, time to get that skin in shape!

Now that winter is here,it is time to rejuvenate and correct your skin. Sun exposure is the biggest environmental cause of skin aging. Blemishes appear, skin wrinkles and loses its luster secondary to the UVA and UVB light rays.  Our minimally invasive treatments such as Laser Micropeel combined with an array of skin care products such as Obagi Nu-Derm System, Obagi Professional-C, and Procyte, can transform and correct much of the damage which has occurred due to excessive sun exposure. Laser Micropeel is a special pulsed infrared laser that treats and softens wrinkles and other blemishes. It also improves collagen production. This treatment helps restore your skin to its natural beauty, making it softer, smoother, and more vibrant. Dr. Bermudez will evaluate how many treatments will be necessary in order to give you the best results and he will also discuss post treatment effects and care with you. There should be minimal discomfort associated with this procedure as a topical anesthetic cream is used. You may feel warming of the skin or a rubber snap like sensation while it is being performed. It is crucial to follow Dr. Bermudez’s aftercare instructions to the best possible results. Obagi Nu-Derm System is a physician-prescribed skin care system that corrects and transforms your skin at the cellular level. As your skin ages, the turnover of skin cells and the sloughing off of old damaged skin cells. Collagen and elastin start to slowly break down, causing the skin to lose its elasticity, resulting in wrinkles and sagging. Daily UV exposure accelerates this process and causes uneven pigmentation. Obagi Nu-Derm System has demonstrated best results in improving mild to moderate photodamaged skin. The initial step is a complete evaluation by Dr. Bermudez and his skin care team. This is followed by non-invasive skincare procedures performed in the office tailored to your specific needs. Most patients only require a topical anesthetic cream, but for the more sensitive patients, a “dental block” with local anesthesia can be performed.

What to do the night before your plastic surgery procedure.

I get this question on a daily basis. Most of the preoperative directions are intuitive, but some are not. Here are some general guidelines, but as with all surgical procedures, check with your surgeon for detailed specifics. Make sure you get plenty of rest, maintain exercise patterns and diminish stress as much as possible. Patients should not ingest alcohol or use tobacco 2 weeks prior to surgery. 

Tobacco use is associated with increased risk for major complication for almost all procedures. Alcohol use can interfere with narcotics use for pain control and lead to stomach ulcers and liver problems. Patients should discontinue use of aspirin, nonsteroidal anti-inflammatory agents, anticoagulants, vitamin E, multivitamins, fish and flax seed oil, homeopathic remedies, and Alka-Seltzer 2 weeks prior to surgery. These substances have been shown to increase bleeding perioperatively. Arnica montana is believed to reduce postoperative edema and bruising when used in the perioperative period. On the morning of surgery, patients should refrain from using cosmetics, perfumes, after-shave lotions, colognes, or moisturizers. On the day of surgery, instruct patients to wear comfortable clothes with a button-down shirt and to bring a scarf and sunglasses.

Breast Feeding and Breast Appearance.

I frequently get asked questions from expecting mothers regarding the effect of breast feeding on breast appearance.  Finally, we may have some good data on this subject.  Findings from a study published in the Aesthetic Journal of Surgery this fall show that, contrary to popular belief, breast feeding is not likely to cause postpartum sagging of the breasts.   Over half of the women in the study reported adverse changes in breast shape following pregnancy.  Post pregnancy drooping of the breasts, also known as breast ptosis, is a common complaint in women which many believe to be linked to breast-feeding.However, as this new data demonstrates, it appears that other things such as older age, greater number of pregnancies, history of smoking, body mass index/obesity, are more significant risk factors factors for the development of postpartum breast ptosis. So, go right ahead and breast-feed your infant. After you’re finished with having all of your children, it may be useful to consult with your plastic surgeon in order to improve the overall aesthetic appearance of your breasts. Many techniques such as mastopexy (breast lift) or breast augmentation can be employed to improve the appearance of your breasts.

Gynecomastia

Gynecomastia is a medical term that originates from the Greek words for "women-like breasts." This condition is far more common than many realize. Gynecomastia affects an estimated 40 to 60 percent of the male population. It may affect only one breast or both. Although certain drugs such as anabolic steroids, medications containing estrogen, alcohol, marijuana, etc., and medical conditions including cancer, impaired liver function, to name a few, may cause or contribute to enlarged male breasts, it is widely accepted that a large percentage of cases derive from unknown sources. Men of any age who are healthy and emotionally stable are considered good candidates for male breast reduction surgery. The best candidates are those who have firm, elastic skin that will reshape to the body’s new contours. In some instances, surgery may be discouraged for overweight men who have not first tried an exercise and diet regimen. Enlarged male breasts can be reduced by liposuction and/or by cutting out excess glandular tissue. The procedure for male breast reduction takes an average of two hours, usually on an outpatient basis, using general or local anesthesia. If excessive glandular tissue, fat and skin is present, it will be removed. Male breast reduction surgery (gynecomastia) may be performed alone or in conjunction with lipoplasty, where the suction device will typically be inserted through the existing incisions. For the removal of excess fatty tissue alone, liposuction may be all that is needed; in such cases, scars will be small and barely visible. Results are permanent, although subsequent obesity can create a gynecomastia-like effect. Some of the benefits of surgery include a firmer, flatter, more contoured chest which may give the male patient a boost in self-confidence. There is little downtime, and you may return to work within one week usually, unless you are involved in strenuous activities. There will be scarring around the nipple of the breast (areola) from this procedure but will fade over a period of time and be less visible. There will be some post-operative bruising, swelling, and burning sensation. To assist with the healing process, the patient will wear an elastic pressure garment for 3-6 weeks and must avoid exposing scarred areas to the sun for at least 6 months. Other considerations include temporary numbness or lack of sensation that could last up to a year. Infrequent complications may include infection, skin damage, fluid accumulation, bleeding, scarring or pigment changes. Post-operative asymmetry, while rare, is possible; a second procedure may be needed to remove additional tissue.

General guidelines for massive weight loss patient’s seeking body contouring surgery, specifically abdominal/trunk contouring. Criteria for insurance coverage (most plans).

Your individual coverage may vary. Medically Necessary: Panniculectomy is considered medically necessary for the individual who meets the following criteria:
  1. The panniculus hangs below the level of the pubis (which is documented in photographs); AND
  2. The individual has had significant weight loss of 100 pounds or more, as well as the following:
    1. the individual has maintained a stable weight for at least six months AND
    2. if the individual has had bariatric surgery, he/she is at least 18 months post operative; AND
  3. One of the following:
    1. there are recurrent or chronic rashes, infections, cellulitis, or non-healing ulcers, that do not respond to conventional treatment for a period of 3 months; information must be documented in office visit records; OR
    2. there is difficulty with ambulation and interference with the activities of daily living; information must be documented in office visit records.
Panniculectomy is considered medically necessary as an adjunct to a medically necessary surgery when needed for exposure in extraordinary circumstances. Not Medically Necessary: Panniculectomy is considered not medically necessary when the criteria above are not met. Panniculectomy is considered not medically necessary as an adjunct to other medically necessary procedures, including, but not limited to, hysterectomy, and/or incisional or ventral hernia repair unless the criteria above are met. Panniculectomy or abdominoplasty, with or without diastasis recti repair, for the treatment of back pain is considered not medically necessary. Cosmetic: Liposuction is considered cosmetic for all indications. Abdominoplasty when done to remove excess skin or fat with or without tightening of the underlying muscles is considered cosmetic. Repair of diastases recti is considered cosmetic for all indications.

I hate my neck!! How long does a facelift last?

I hear this question a lot. A long term study that was recently published in December of 2012 demonstrates long lasting results of facelift surgery. Subjective and objective measurements showed lasting improvements in key areas such as jowl and jaw line, neck and overall appearance. The study provided strong evidence that facelift surgery can provide significant long-term aesthetic gains. The key point to take from this study is that the majority of patients will still look younger 5 + years after a facelift than they did prior to the facelift. This study also supports facelift surgery as the only rejuvenation technique to have objective and subjective evidence for long term efficacy, emphasizing the current lack of evidence of other interventions. For patients who have no issues with their face, but are concerned about slack skin around the neck, Dr. Bermudez recommends neck lift surgery. This tightens the neck, and reduces “cords” that many patients find undesirable. If you like to get a neck lift in San Francisco, contact Dr. Kenneth Bermudez today. Hope this helps. Good Luck.

When is it OK to exercise after abdominoplasty? Can the sutures “pop”?

Abdominoplasty or “tummy tuck” is a procedure where skin and fat are removed from the lower abdomen.  It is usually performed as part of the “mommy makeover”. The recovery can be significant when compared to other aesthetic procedures because the abdomen and its muscles are used for just about everything we do, from breathing to sitting to standing to talking. Expect full recovery at about 6 weeks. I allow most of my patients to return to light exercise 1 month after surgery. Return to unrestricted activity in 6-8 weeks. Sutures are placed both internally to tighten loose abdominal muscles or superficially to close the skin. Yes, they can “pop” or come loose with heavy coughing, vigorous exercise or exertion. Most patients have healed adequately by 4-6 weeks, so that this rarely occurs. Hope this helps. Good luck.