Salzman Cosmetic Surgery and Spa featured in January 2016 Issue of Today’s Woman Magazine

Salzman Cosmetic Surgery and Spa was a Finalist in Today’s Woman January 2016 issue “Best For You” Reshape/Contouring list of cosmetic surgery practices! Read the full excerpt below or click here to view the digital version of the January 2016 issue!

“There’s no one-size-fits-all approach when it comes to getting rid of unwanted fat and improving the contour of the face or body. ‘One of the advantages of going to a plastic surgeon is that depending on what the patient needs, we can offer everything from invasive procedures like a tummy tuck to less invasive laser liposuction to completely non-invasive modalities like heating and killing fat cells with Vanquish treatments,’ says Dr. Marc Salzman. The board-certified plastic surgeon has recently added the CoolSculpting PLUS to his arsenal. ‘I think it’s the latest and greatest thing in non-invasive fat reduction,’ he says.”

 

How to Pick the Right Size and Shape of Breast Implants

One of the questions I’m asked most as a plastic surgeon by patients considering breast implants is, “how do I know what size and shape I need?” The answer has changed dramatically throughout the 25 years that I’ve been performing breast augmentations.

Along the way, I’ve learned that the words that our patients use to describe what they want or don’t want can be completely misleading into what I interpret their meaning to be. Therefore, if you are considering breast augmentation, I like to request that you bring in photos of what you like and don’t like. Fortunately with the internet, there is a multitude of sources where these photos can be downloaded. By looking at your desires, I can get a better understanding of what you want.

As for trying implants “on”, we no longer recommend that you place the exact implant on top of your breasts and then place a stretchy bra over it to give you an idea what that implant under the muscle would look like after surgery. That method will always exaggerate what the actual result will be. However, if you are going to use a sizing type method, then Mentor makes a shell sizing system that accommodates for the sizing difference between the actual implant and what it would like.

Our preferred method is a 3-D imaging system called Vectra® that we have been using since it started. At your visit, a three-dimensional photograph of you is taken and you and I are able to review your options together using your image on a large television. We can place all of the different implants that are available and decide what size, shape, fill ratio, and height to base width relationships will look best for you.

Silicone gel breast implants come either round or shaped. They also come with either a textured or smooth surface. There are advantages and disadvantages of every scenario and combination of those choices, and I specially tailor my choice to each patient. Most of the time a round smooth implant placed under the muscle works very well for breast augmentation patients. Sometimes we choose a textured implant, as they tend to migrate less in the pocket due to some frictional resistance to motion, which is why all shaped implants are textured. An added reason to choose textured implants is that the capsular contracture rate is less than for smooth implants, especially when implants are put above the muscle.

We like to start with a measurement of the base width of the breast. We then subtract about a centimeter and a half off of that number to ensure enough coverage of breast tissue over the implant, and use that number to find corresponding implants. If we go larger than that number, which sometimes patients will want, we know that it increases the risk for more problems. For instance, larger implants may migrate below the natural breast crease and when that happens, they can create a second crease in what we call a “double bubble.” Large implants can also thin out the breast tissue, because of the added pressure.

After we have the base width, our next choice is the projection to correspond with our decision. There are typically four choices ranging from fairly flat (low-profile) to progressively more height (ultrahigh-profile). More commonly used for a natural look are the ones in between: moderate profile and moderate profile plus. We would choose the taller profiles for patients who want a larger look than their natural base with would allow or have a fair amount of loose overlying skin that we’re trying to hold up.

Patients will often present with breasts that are different sizes. One of the options to correct this is to use breast implants of different sizes in order to create a more symmetrical appearance. A newer method is to do a hybrid breast augmentation, where the patient has matching silicone gel implants placed and the overlying breast tissue can be made to look the same in volume and shape by using fat grafting. This allows for the patient to fluctuate more in weight and age and the breasts are more likely to have the same or similar sizes. When it comes to symmetry, I like to tell our patients that they should consider their breasts to be sisters that live across the railroad tracks from each other rather than twins.

There are also shaped implants. Rather than being perfectly round, these implants can either be taller than they are wide or wider than they are tall. For patients with very widely spaced breasts and a large breastbone, a shaped implant that’s wider than it is tall can help hide that a little bit. Shaped implants are also an option for a patient with skin laxity after childbirth or great weight loss; when the nipple is just at the level of the inframammary crease, we can sometimes get away with a tall implant to give the appearance of a slight lift without having to do a mastopexy.

A new style of silicone gel implant has recently surfaced that is filled to a higher volume in the shell. This allows for a round smooth implant to collapse less in the upright position mimicking more of the look of the shaped implant. When patients show me a photo of a very rounded upper part her breast, I would likely choose one of these higher volumes implants such as the Natrelle Inspira® silicone gel breast implant.

By spending some time before the operation takes place, using the Vectra® 3-D imaging method with computer animation, we can decide what type, shape, and ratio of width to height would best serve your needs. Doing this avoids the placement of sizers at the time of surgery, which, in my opinion, have a few negative implications, including additional cost and unnecessary disruption to the breast pocket, increasing bleeding risk.

With proper preoperative planning and flawless execution of breast augmentation, this can be one of the most satisfying aesthetic plastic surgery outcomes for both patients and physicians.

October 2015 Issue of Today’s Woman

Check out our two-page ad in the October 2015 issue of Today’s Woman magazine! Join us for our Find Your Fabulous event on Thursday, October 15th from 4-7pm. And read about the top 10 spa treatments to try! View the full digital version of the issue by clicking here! Our ad is on page 4 and 5.

We’re giving away $2,000 in prizes! Click the link below for details!
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Salzman Cosmetic Surgery and Spa featured on WAVE 3 News

September 8th, 2015
WAVE 3 News
Focus On Health

Dr. Salzman was recently featured in a story on WAVE 3 News about the new non-invasive procedure, Vanquish. This procedure is offered at our practice and is getting great reviews from patients! The title of the story on the WAVE 3 News website is, “Melting the fat away: new procedure shaves inches off your midsection.”

Click here to read the full article and watch the video on the story!

http://www.wave3.com/story/29980382/melting-the-fat-away-the-new-procedure-that-shaves-inches-off-your-midsection

The Importance of Certification in Plastic Surgical Nursing

Dr. Salzman fosters personal and professional growth of his registered nurses. He understands the value of education, administration, and research within his clinical practice. Dr. Salzman employs two registered nurses who are board certified.

Kim Pickard, RN, BSN, CPSN has worked with Dr. Salzman for 13 years. Kim’s area of expertise focuses on invasive surgical procedures. Her current position as Nursing Administrator encompasses supervision of the surgery center, as well as, implementation of nursing protocols.

Suzanne Ramsey, RN, BSN, CPSN, CANS has 13 years of plastic surgical experience. Her knowledge encompasses patient education, pre and post-operative care, and noninvasive procedures. Suzanne’s primary focus presently is the medical spa comprising of many types of lasers, radiofrequency devices and facial injectables. Her extensive knowledge of injectables include Botox, Dysport, Xeomin, Perlane, Restylane, Juvederm, Voluma, Radiesse, Belotero, Prevelle Silk and Sculptra.

The American Board of Nursing Specialities (ABNS) defines certification as “the formal recognition of the specialized knowledge, skills and experience demonstrated by the achievement of standards identified by a nursing specialty to promote optimal health outcomes” (ABNS, 2004). Obtaining specialty certification validates that a nurse has advanced from an entry level of competency to a higher level of practice encompassing knowledge and clinical judgement (Wilkerson, 2011). Certification promotes public safety, quality nursing care, clinical expertise and professionalism among nursing colleagues, patients and the public (Briggs et al, 2006). Professional recognition for these achievements is provided through certification.

Certified nurses go beyond licensure to validate their specialty knowledge through a rigorous national examination. They are known as clinical experts and are dedicated to providing quality and evidence-based clinical care. Certified nurses are committed to life-long learning, patient advocacy and professional practice. Throughout their career, there is a commitment to continuing competency by reassessing their knowledge through specialized continuing education.

The Plastic Surgical Nurses Certification Board (PSNCB) was established in 1989. The Board’s purpose is to promote the highest standards of plastic surgical nursing practice through the development, implementation, coordination and evaluation of all facets of the certification and recertification processes. The Certified Plastic Surgical Nurse (CPSN) exam is offered to nurses meeting specified criteria. Eligibility to take the exam includes having a minimum of 2 years of plastic surgical nursing experience as a registered nurse in a general staff, administrative, teaching or research capacity within 3 years prior to application and having spent at least 1,000 practice hours in plastic surgical nursing during two of the preceding three years. Recertification through continuing nursing education contact hours is accomplished by accumulating 45 contact hours during a 3 year period of time.

American Board of Nursing Specialties (ABNS). (2004). Retrieved from http//www.nursingcertification.org.

Briggs, L.A., Brown, H., Keston, K., & Heath J. (2006).  Certification: A benchmark for critical care nursing excellence.  Critical Care Nurse, 26(6), 47-35.

Wilkerson, B., (2011). Specialty nurse certification effects patient outcomes.  Plastic Surgical Nursing. 21 (2), 57-59.

CoolSculpting® is Here at Salzman Cosmetic Surgery

Coolsculpting® by Zeltiq is a method of cryolipolysis. This uses freezing of fat to destroy it permanently. When Coolsculpting® first came out years ago I was hesitant to jump on board and offer it to my patients for a few reasons. At that time they only offered a small applicator that fit only one area over the abdomen. No other body areas other than a part of the belly could be treated. The concept has changed full circle and now with the addition of several new applicators, the process has migrated to a regimen called “treat to transformation”. The applicators are now overlapped somewhat such that a smoothing effect over the entire surface area of the abdomen can be achieved. Also, with new curved applicator heads, areas such as the hips, thighs and bra strap areas can likewise be treated successfully. The treatment consists of a negative pressure suction applied over the area until the skin and fat are positioned between two metal plates that then cool the area for one hour. The frozen fat is naturally removed from the body resulting in a permanent loss in the area treated. The result is a more sculpted appearance. The process is completely non-invasive and requires no post procedure changes in what you can do as far as work or exercise. The vast majority of patients can have this done while using their computer, watching a movie or simply relaxing in the chair. Side effects are minimal and short lasting. Best candidates for CoolSculpting® are at or near their goal weight and have at least an inch of skin that you can pinch away from the area. Our CoolSculpting® certified technicians can examine you and see if you’re a candidate. Who ever thought losing inches could be so “cool”.

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Our New Location

After 22 years in the same location, we have finally moved! Our new location at 4702 Chamberlain Lane, Louisville, KY 40241 with 8,000 square feet was designed around the way our practice has changed over the last two decades. We have added a state-of-the-art operating room, three private pre and post-op recovery suites as well as additional capacity for both our surgical patients and medical spa clients.

Derek Engineering and Barry Wooley Designs have done an exceptional job at constructing and finishing a lush, beautiful office environment that has had very positive first impressions in the few weeks that we have been open. We have added new staff in both nursing and administrative support to streamline our delivery of exceptionally compassionate, caring and skilled services of our surgical spa treatments. In the near future, we will be adding additional appointment times in the early mornings, evenings and Saturdays. All of us at Salzman Cosmetic Surgery and Spa are excited about our new space and we hope to see our established patients as well as new patients in this beautiful new space soon!

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Plastic surgery practice moving to Louisville’s ‘new epicenter’

We are moving to a new location that will open on Monday, December 15th! The new location will be in the East End of Louisville and will be twice as large as our previous office space!

Louisville Business First wrote a short article on the move, click the link below to read it!

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http://www.bizjournals.com/louisville/news/2014/12/08/plastic-surgery-practice-moving-to-louisvilles-new

Your Fat May Be Your Best Filler

We all have often thought, “If only I could move this stubborn fat around my waist to somewhere else where it might look better.” That concept today in Plastic Surgery is becoming more of a reality. The process is called fat transfer and has exploded in its usefulness in our Plastic Surgery practice. The technique involves removing fat from where it is in excess, like around the midsection and transferring it to where it may help increase the size or fill in areas where fat has been depleted. Common areas to place fat are for increasing breast size, matching size or shape of breasts, making buttocks larger, and filling out of the face that has sagged with weight loss or age. Several rather new modalities have made fat grafting better over the last few years. We now know that the addition of growth factors from platelets, when added to fat grafts make the fat grafts heartier and more likely to gain a blood supply and survive the transfer. In our office, we have used PRP (platelet rich plasma) as a source of these growth factors for over 2 years now and have seen better results with fat grafting since its implementation. Also, it has been recognized that placing fat into muscle which has a better blood supply makes it easier for the fat to survive. We have used ultrasound now to actually see where the fat goes and place in places that will make it more likely to survive. There have also been fair amounts of research into better ways to both harvest the fat and separate out those components that represent the cells most likely to survive.

At the Salzman Institute of Plastic Surgery in Louisville, KY we have been utilizing these advanced techniques with great success in the last few years. One of the new concepts this fat grafting has helped is in High Definition Liposculpting. The fat is removed from the areas where it is in excess and replaced into where accentuation of natural underlying muscle mass is needed. Under ultrasound guidance, these fat grafts can by placed directly into the underlying muscles safely. We also use this same technique in reshaping of the breast. Rather than relying on breast implants alone, fat usually taken from around the belly and hips can be placed into the breast to enlarge and reshape it. Nice contours of natural feel and look can be accomplished in this way.

Fat, it turns out, can be a nice commodity if moved to a more desirable location with newer plastic surgery techniques.

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