Dr. Wittpenn, where do your patients come from and how do they get referred to your practice?

In addition to serving the local Nacogdoches and Lufkin area, many of my patients come from throughout East Texas, as well as from Tyler, Dallas, Houston and Shreveport, LA.  I also see patients from other states, most of who have been referred by former patients of mine.  I feel fortunate knowing that almost all of my patients – regardless of where they live – come to me by way of word-of-mouth from either former patients or medical colleagues.   My staff and I are proud of the fact that new patients hear about us from individuals who are happy with their surgical outcomes and with the overall level of care they experienced in our center.

In your opinion, what is the optimal age to seek plastic surgery?

The most important thing I can say about this is that I don’t go by chronological age but by physical age.  I see adult patients of all ages – from as young as 18 up to those who are well into the 70’s – both women and men.  I find that a growing number of my female patients schedule consultations with me after their children are grown.  They’re still vital, fit, and at a point in life when they have the time, the means, and the opportunity to do something for themselves.  Choosing a surgical or non-surgical cosmetic procedure gives many of my patients a tremendous surge in confidence – a good thing at any age, if they are healthy and have realistic expectations.

There are certain procedures that can be done on very young people, such as correction of protruding ears.  This can make a world of difference in how they see themselves and how other respond to them.  There’s no reason to wait years to correct a physical characteristic that fosters self-consciousness and insecurity.

Rhinoplasty (nose) surgery is another procedure that can be done, in many cases, once a young person reaches physical maturity in their  later teens.  The self-consciousness experienced by young people who contend with obvious physical flaws is something I take seriously.  For many of my young – as well as my older- patients, these procedures can be positively life changing.   For instance, the difference between a nose with a prominent bump and one that has been reshaped is often dramatic.  One of the things I like best about plastic surgery is the fact that a subtle alteration in the chin or nose can change the entire facial appearance  – bringing the features into harmony with one another.  The improvement in appearance is gratifying, to my patients and to me.

Breast enhancement surgeries can be done on women 18 years or older, and women well into the 60’s who are in good health are increasingly choosing these procedures.   With tummy tucks and/or liposuction, the age range tends to be from the 20’s into the 50’s and even into the 60’s, assuming the individual is in good overall health.

For liposuction, age isn’t always as important as the quality of my patient’s skin.  When there is a good deal of skin laxity, liposuction alone can result in even more loose skin, and that’s not what we want.  In these cases, a tummy tuck is the way to go, with liposuction removing excess fat and the tummy tuck reshaping the body.  That being said, some women and men have firm skin tone even when they’re older, and these individuals often get a great result from liposuction.

Patients who come to me for breast reconstruction surgery, of course, typically have their procedures done following mastectomy surgery, so circumstances dictate the timing, rather than the age of my patient.

Tell us about your consultation process with new (or returning) patients.

My consultations tend to be lengthy and comprehensive, no matter which procedure- or multiple procedures – a patient is considering.  The most important comment I want to make in this regard is to clarify my position that each patient needs to be intimately involved in the decision making process.  As a plastic surgeon, I fully explain all options available and discuss these with my patient at length.  However, it’s her face and her body and I want my patients to have enough time to talk about what they’d like to change and to feel comfortable describing their appearance goals, their preferences, and any concerns they may have.  I consider the time spent meeting with new – or returning – patients in consultation to be valuable and time well spent.  As their doctor, I certainly let them know what their options are and what can and cannot be accomplished, but I want my patients to take an active role in the decision-making process.

Your practice has an excellent reputation for breast and body procedures, as well as for facial plastic surgery.  Tell us about the types of plastic surgery procedures you perform.

Yes, in addition to facial surgeries, I’ve been fortunate to establish and build a robust patient-to-patient referral base of women who choose breast and/or body procedures.  Let me briefly discuss each of these:

Facial Plastic Surgery

Facial procedures are performed on patients over a wide spectrum of ages, depending upon the patient’s particular facial structure and the way that face is aging.  For instance, there are women in their 30’s who have inherited a tendency to develop jowls or excess fat in the lower face or chin area.  Liposuction and/or a facelift can literally transform their appearance, taking years away from their appearance and turning an ordinary face into a very attractive face.

Facelift: Some of my patients require a full facelift, particularly if they want long-lasting results and they’re not going to get the outcome they want from lesser procedures.  A facelift takes 10 years away, on average, from the face and it should look natural – not obvious.  Other patients of mine – particularly if they are younger but have always had slackness or surplus fat in their lower face and neck – benefit tremendously from a neck lift and/or liposuction of the neck.

Facial implants: Facial implants can make a wonderful difference for a patient with a receding chin, for instance, or with insufficient cheekbone structure.  The cheek prominence tends to slide downward over the years, giving the face a gaunt, older look.  Facial implants are sometimes the best way to bring a face back into balance – particularly when the chin is weak.

Brow lift: Many of my patients choose to have a brow lift in addition to the facelift, as it addresses the upper part of the face and opens the eye and brow area for a more rested, youthful appearance.  I do both the traditional brow lift and the endoscopic brow lift and determine which is best for my patient during their consultation.

Rhinoplasty: For me, one of the most rewarding surgeries to perform is rhinoplasty.  The nose is the most personal feature on the face, when you think about it.  It’s unique to the individual, and each nose is distinctly different than any other nose – even for those in the same family.  Because it’s such a distinctive feature, a good rhinoplasty demands tremendous skill and experience from the surgeon, if the patient is going to have the result they want.  Sometimes it requires a subtle revision – just the tip of the nose, say – and sometimes more resculpting and reshaping is required to get the optimal outcome.  It’s challenging, exciting surgery to perform – and gratifying.  A good rhinoplasty makes the whole face look better.

In addition, you have to remember that the nose is not just a decorative feature; it’s functional…and it needs to function properly.  Frequently we will address internal problems of the nose that affect breathing.

Rhinoplasty is the most technically tricky of the facial surgeries, in my view.  My goal is to give my patient the improvement he or she wants and that’s certainly my patient’s goal, too.  Still, I’m well aware that we are going to physically alter a feature that’s been a key part of my patient’s identity for many years.  That means my patient has to be comfortable with what he or she wants and I have to make sure that it can be done in a way that yields the best possible result.  It has to please my patient, it has to please me, and it has to work the way it’s meant to work.

Blepharoplasty:

Eyelid surgery – whether just upper lid or both upper and lower – is a straightforward, relatively simple surgery to perform and my patients really like the results.  The recovery time is brief, and the procedure opens the eyes up, taking years off the face.  It’s safe, it’s quick, and it works.  Usually, my patients who choose eyelid surgery have grown weary of being told they look tired.  Sagging upper lids and bags under the eyes will do that.  Take those flaws away and the face looks more alert, clear, and definitely more attractive.

Body Procedures

Let’s start with plastic surgery options for those who want breast enhancement. The increase in the number of women seeking these procedures is nothing short of phenomenal. In my practice, I perform the full range of breast enhancement procedures, including augmentations, breast lifts, breast reduction, and breast reconstruction.  Each patient is different and, depending upon her goals, helps to determine which individual procedure – or combination of procedures – she wants.  For instance, many women who are done with their childbearing years achieve the optimal results by combining breast implants with a breast lift to restore a natural, more youthful shape and contour.  For large-breasted women, sometimes a lift is sufficient; for others, breast reduction is the better choice.

My patients are generally educated about breast enhancement surgical procedures before they come to see me.  They’ve talked with other women who have undergone enhancement procedures, they’ve read about the procedures online and looked at before and after photos, and many are referred by former patients of mine who have been kind enough to share their experiences with them.  This gives them a certain level of comfort right from the beginning of the process.

This is a great time to seek breast enhancement, because women have options and surgical techniques have been improved and refined over the years.  Besides taking physical measurements and assessing the woman’s particular body type and structure, my consultation patients have the opportunity to try on different implants in order to determine the size and shape they want to achieve.  They also learn about saline and silicone implants and we talk about the benefits of each.   I also let new patients know that it takes several months for their new breasts to “normalize,” which means to settle into the body and take on the shape and position they will retain once the healing process is complete.

Price is also an issue for some patients, with silicone implants costing more than saline. although we offer payment options.  And, despite the extensive research that’s been done to prove their safety record, some of my patients express their apprehension about silicone. I take all the time each patient needs to educate and to answer questions.  I want her to know everything she needs to know in order to decide which choice is best for her and what is required for her to recover quickly and comfortably.

Traditional Liposuction and VASER-Assisted Liposuction

I really like doing liposuction, which gets at fat pockets resistant to diet and exercise and often bring a patient who’s body has been out of proportion back into proportion – when nothing else works.  I’m getting wonderful results with the VASER liposuction procedure.  It’s an innovative piece of equipment and it allows me to do finely tuned sculpting with less down time for my patient.  In consultation, my patient and I decide together which procedure is best for them – whether it will be traditional lipo or VASER.

The so-called “Mommy Makeover” is something you hear a good deal about in the media, and for good reason.  Once a woman has completed her childbearing years, she can seek one or more procedures that will give her back the body she had before bearing children.  In many cases, she can look even better than she did before she had children.

Each woman is different and has different appearance goals, but a growing number of my patients choose abdominoplasty (tummy tuck) to flatten the abdominal area and tighten the underlying muscles.  Many combine this with liposuction and – in some cases – labiaplasty.  I also have patients who combine breast enhancement – particularly after nursing one or more children – with a mini or full tummy tuck.  These women have a lot of years to live and they want to look their best.

The body lift – sometimes called body re-contouring – is the last type of surgery I’ll mention for now.  After a major weight loss, you’ve seen how many women and men are left with sagging, hanging skin.  This condition can be corrected, depending upon the needs of the individual patient, with an arm lift, thigh lift, tummy tuck, breast lift, or a combination of different procedures that remove excess skin and give the patient back a normal looking body.  For men, breast reduction surgery is often the way to go and the results are terrific.

Dr. Wittpenn, tell us about non-surgical options that you offer your patients seeking rejuvenation.

Laser resurfacing of the face is typically the best option for women who have overexposed themselves to the sun and elements for years.  Again, age is secondary to skin condition.  I see women in their 60’s with beautiful skin.  They’ve stayed out of the sun, used Sunblock, and taken very good care of their skin.  On the other hand, I’ve treated many women in their 30’s who need resurfacing in order to repair the damage done to their complexion and skin tone from the sun.

Correcting sun damage and reversing the signs of aging on the face, neck and chest often calls for a blend of treatment strategies. We like our patients to develop a serious skin care regimen that will treat existing sun damage and prevent further damage.  We are particularly pleased with Obagi, a medical grade skin care line that works very well.

Many of my patients also benefit from chemical peels and the depth of the peel is determined by evaluating the extent of the sun damage and overt signs of aging.  We offer the Lumenis fractional CO2 laser with Active FX and Deep FX for skin tightening, wrinkle reduction, as well as improvements for skin texture and discoloration.

Botox, Juvederm, and Radiesse fillers are very popular with our patients, since they yield an obvious result right away and can take years off the face.  I do many of these treatments myself, and have a highly qualified assistant who does a great job.  I also do lip augmentations for those who want to improve thinning lips.

Why is choosing the right surgeon so important?  Is it true that any doctor with an MD degree can perform cosmetic surgery procedures?

Unfortunately, yes.  What this means is that a doctor who practices family medicine, for instance, can take weekend courses and then decide to offer cosmetic surgery procedures.   Certainly there are competent doctors who do this without being board certified plastic surgeons.  However, I firmly believe that it’s in the best interest of consumers to seek out a doctor who is Board Certified by the American Board of Plastic Surgery.  They have rigorous standards that must be met before a doctor is certified.  It makes a big difference.  It’s a safety issue, and it’s an aesthetic issue, too.  You only have one face and one body.  You have to be careful and ensure that the doctor you choose is someone you can trust to give you the optimal outcome and the best care.

In your opinion, what is the biggest risk involved in seeking a plastic surgery procedure?

Without a doubt, it’s critical to choose a surgeon who is highly trained, Board Certified as a plastic surgeon, and experienced to do the surgery you desire.

You have been involved with a volunteer organization called Faith in Practice for years.   Will you tell us about it?

Faith in Practice was started in 1992 by several people who identified the profound need for medical care among the poor in Guatemala.  They sent a team of 12 doctors the first year, and it’s been growing ever since.  Antigua, Guatemala is the base for Faith in Practice’s medical and dental teams.  Each doctor volunteers their services for a week, with some teams working at the hospital in Antigua and others traveling to villages in the countryside to provide medical and dental care to those in need.  I’ve been blessed to participate with 8 of these medical missions so far, between Faith in Practice and other organizations, performing surgeries, and I will continue to go in the years to come.

With the summer mowing season approaching, the American Society for Reconstructive Microsurgery (ASRM), American Society of Plastic Surgeons (ASPS), American Society of Maxillofacial Surgeons (ASMS), American Academy of Pediatrics (AAP), and American Academy of Orthopaedic Surgeons (AAOS) are working together to prevent injuries and educate adults and children about the importance of lawn mower safety.

“Lawn mower injuries are not only among the most devastating I’ve seen in over 20 years of practice, they are also the most preventable,” said ASRM President Peter Neligan, MD. “When a lawn mower injury happens to a child it is even more devastating because it is invariably due to the inattention of an adult. Don’t let your life or the life of your child be irrevocably changed by a moment of inattention.”

Many lawn mower-related injuries require a team of physicians from various specialties – plastic surgery, microsurgery, maxillofacial surgery, pediatrics, and orthopaedics – to properly repair them. Often, patients must endure painful reconstructive operations for months, sometimes years, to restore form and function.

“Lawn mower injuries often include deep cuts, loss of fingers and toes, limb amputations, broken and dislocated bones, burns, and eye injuries,” said ASPS President Michael McGuire, MD. “Most are caused by careless use and can be prevented by following a few simple safety tips.”

Read more on plasticsurgery.org

“The industry has experienced some economic downturn during the later part of the decade due to the recession, but, overall, plastic surgery has seen growth in the first decade of the new millennium,” said ASPS President Michael McGuire, MD. “The current economic climate will likely not have an impact on long-term growth. The largest contributor to the increase in procedures over the past decade has been the advent of injectable wrinkle fighters and other minimally-invasive procedures.”

Cosmetic minimally-invasive procedures increased 1 percent, to nearly 11 million procedures in 2009. Minimally-invasive procedures are up 99 percent since 2000. The top five minimally-invasive procedures in 2009 were:

• Botulinum toxin type A (4.8 million)
• Soft tissue fillers (1.7 million)
• Chemical peel (1.1 million)
• Microdermabrasion (910,000)
• Laser hair removal (893,000)

Read more on plasticsurgery.org

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