Online Health Chat with J. Vicente Poblete, MD

October 19, 2017


Description

Cleveland Clinic plastic surgeons have been pioneers in the field of cosmetic and plastic surgery. Each of our board-certified surgeons performs a large range of body contouring services, with extensive expertise in alternatives to face- and neck-lift surgery, short-scar facelifts and minimally invasive facelift techniques. Services can range from nonsurgical facial rejuvenation (such as BOTOX, injectable fillers and KYBELLA) to surgical procedures (such as liposuction, eyebrow and neck lifts, breast surgery, ear reconstruction, tummy tucks, arm and body lifts, buttocks lifts, facial implants, cosmetic nose surgery and surgery after significant weight loss). These procedures can help restore your youthful appearance, re-awaken your natural beauty and help make you feel more confident.


About the Speaker

J. Vicente Poblete, MD is an associate staff physician in the Department of Plastic Surgery at Cleveland Clinic. Dr. Poblete’s special interests include cosmetic and facial plastic surgery and reconstructive surgery. He is board certified in both general surgery and plastic surgery. He is a member of both the American Society of Aesthetic Plastic Surgery and the American Society of Plastic and Reconstructive Surgeons.


Let’s Chat About Plastic Surgery

Quest for Breast Facts

Nett: I am interested in breast reduction. I am a Cleveland Clinic patient and have had back surgery. Would my insurance cover breast reduction? Can I get pre-authorization by  seeing a surgeon and having him or her submit a reason for surgery, rather than seeing my primary physician then having to see specialist?

J_Vicente_Poblete,_MD: Let us talk about breast reduction first. This is one of the more common procedures we do. It results in very high patient satisfaction, as patients report to me. Insurance coverage varies from company to company, so it would be hard to accurately answer your question. When patients come in to see us for a visit, we do the exam, take pictures and send a letter of pre-determination to that patient's insurance company. Please check with your insurance company to determine if you require a primary care referral before seeing a specialist. Thank you.

timeofyourlife: Good afternoon. Is it safe to get a breast reduction before you breastfeed?

J_Vicente_Poblete,_MD: Good afternoon, as well. It is recommended that you are done with breastfeeding before any elective breast surgery. I usually recommend waiting at least three months after breast feeding is done. Once you stop breastfeeding, the breasts gradually get smaller and may sag more. It is best to get these changes over with, so when the procedure is done, a more accurate volume removal and lifting can be done. Thank you.

timeofyourlife: Is it safe to get a breast reduction before kids, or is it better after?

J_Vicente_Poblete,_MD: I always recommend that childbearing be done BEFORE any elective breast surgery, such as a reduction or augmentation (breast implant) surgery. The hormonal changes with pregnancy profoundly affect breast size and volume. Doing breast surgery and then getting pregnant may reverse the desired improvement brought about by the breast surgery and may increase the need or desire for revision surgery or re-operations. I recommend waiting at least three months after delivery or after breast feeding before undergoing any elective breast surgery.


Exploring the Eyes

Carie: I am a 66-year-old female with saggy upper eyelids. What are the pros and cons of eyelid surgery versus a brow lift? (My lower lids are fine; it's just the uppers.) Thanks.

J_Vicente_Poblete,_MD: Most of the time, "saggy or hooded lids" are caused by both excess upper lid skin and brow ptosis, or drooping. Eyelid surgery alone will partially improve the concern, but adding brow lift surgery may enhance the results. The trade off is a more extensive surgery, added risks and a longer operative time and recovery. Thank you for your query.

Alberta: Good morning. Could you please advise the extent of plastic surgery needed to correct drooping eyelids that extend a few centimeters below the eye, as well as the tightening of the upper eyelids? Is there any risk involved in the surgery?

J_Vicente_Poblete,_MD: The first step would be to get a visual field exam. Once this is done, a consultation will help to determine if the procedure would be simple skin removal or involve tightening the muscle to elevate the eyes. As in any surgical procedure, there are risks to surgery, and this can be discussed in more detail during the consultation.

Sharbear1969: I’m worried about sagging around my eyes. How successful is the plastic surgery under and above the eye for this? What is the recovery time?

J_Vicente_Poblete,_MD: There are two issues to address here, upper lid surgery and lower lid surgery. Both are effective, and they can be done one at a time or simultaneously. When done at the same time, the procedure is more involved, as is the recovery. Recovery, unless postoperative issues arise, is usually one to two weeks. Thanks for your query.

Sharbear1969: Is it recommended to do both upper and lower eye at same time?

J_Vicente_Poblete,_MD: The decision to do both at the same time depends on the extent of the correction needed. Having said that, it is common to do both upper and lower lid rejuvenation at the same time. The advantage is one recovery phase

Flatteners and Fillers

NoelleB: Hi. I am thinking about getting lip fillers to enhance lip volume, especially my upper lip. How long do the results last? How often should you get more filler?
 
J_Vicente_Poblete,_MD: There are various fillers on the market. For lip augmentation, I usually use JUVÉDERM Ultra (or JUVÉDERM VOLBELLA) or Restylane Silk. The results usually last six to 12 months depending on the individual. There is no required frequency of injection. You would come in whenever you want the volume correction. Thank you for your query.

Carie: What can be done for hollowness under the eyes (no bags, just hollowness)?

J_Vicente_Poblete,_MD: Sometimes, depending on the extent of the problem, fillers can be used to address this concern. Thank you.

Carie: What type of filler would you suggest for under eye hollowness with no bags?

J_Vicente_Poblete,_MD: JUVÉDERM Ultra or Restylane are options for the under eye or tear-trough areas. Thank you.

timeofyourlife: What is the difference between fillers and BOTOX? Which is best for lines around the eyes?

J_Vicente_Poblete,_MD: BOTOX, one of the neurotoxins available, works by relaxing dynamic lines, lines that are exaggerated by animation, forehead lines, frown lines and smile lines, also referred to as "crow's feet" lines. Because it is very effective, it is the MOST common nonsurgical cosmetic procedure performed. Fillers, as the name suggests, are better used for volume enhancement and correction. The deepened nasolabial folds, facial hollowing and jowl areas respond best to fillers.


Surgical Solutions

barbiedoll: Where is the incision made for a neck lift, and is there a high-risk for scarring on African American skin? Thank you.

J_Vicente_Poblete,_MD: Depending on the amount of skin laxity and associated fat, the incision can be done in the chin area or may include incisions behind the ear onto the posterior hairline. The more pigmented and thicker the skin, the higher the risk of unfavorable scarring. Thank you.

Carie: I had a full facelift eight years ago with good results. Gravity continues to take its toll, however. Would there be any difficulty doing another facelift in the future?

J_Vicente_Poblete,_MD: It is possible to do a secondary facelift. Facial aging is dependent mainly on two factors, your genetic predisposition to skin aging AND photoaging, or aging due to sun damage. Everyone is different in this regard, so after a facelift, how skin changes will be different from one person to another. As such, the timing for secondary facelifts will vary from individual to individual.


Closing

That is all the time we have for questions today. Thank you, Dr. Poblete, for taking time to educate us about Plastic Surgery.

On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online.

For Appointments

To make an appointment with Dr. Poblete or any of the other Cleveland Clinic cosmetic specialists, please call 216.444.4004. You can also visit us online at clevelandclinic.org/beautifulyou.

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About Cleveland Clinic Dermatology & Plastic Surgery Institute
The Dermatology & Plastic Surgery Institute offers patients a full range of dermatologic, reconstructive and aesthetic services. Our specialists focus far beneath the skin. Dermatologists and plastic surgeons at Cleveland Clinic are as concerned with function as with appearance. They collaborate in a multidisciplinary setting with ear, nose and throat specialists, ophthalmologists and dentists to provide the highest level of care and to ensure that patients’ varying aesthetic needs and functional requirements are met.

The Department of Dermatology includes more than 30 dermatologists who offer a full array of subspecialized care for adult and pediatric patients. Our physicians provide expert diagnosis and treatment of all disorders of the skin, hair and nails, whether primary or related to an underlying systemic illness, including industrial-related conditions. The department also offers a full range of procedures in the area of dermatologic surgery, including laser surgery, soft tissue augmentation and Mohs micrographic surgery. Additionally, our Cutaneous Care Center provides outpatient treatment, utilizing phototherapy and excimer laser treatment, for patients with psoriasis and other chronic skin diseases.

The Department of Plastic Surgery includes more than 15 board-certified plastic surgeons, making it one of the largest plastic surgery departments in the country. Our specialists have significant experience and expertise in all areas of aesthetic and reconstructive plastic surgery, especially in the areas of facial cosmetic surgery, cosmetic and reconstructive breast surgery, pediatric craniofacial surgery, upper extremity surgery, reconstructive microsurgery and plastic surgery research. For the past several years, the department has focused on minimally invasive techniques in facial cosmetic surgery. This includes alternatives to face and neck lift surgery, short scar facelifts and minimally invasive facelift techniques.

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