| FAQ
The questions listed
below have been put together by Dr. Kremer
and Dr. Zettl from email inquiries as well as from personal
consultations.
The questions are being updated constantly
and are included here to provide you with additional information.
Should you
have any questions yourself, please feel free
to email us through our Contact
Us page.
This is a question to Dr. Michael Kremer: I am
a 24-year old male from Dhahran/Saudi Arabia.
Even though I accept that a rather large nose
with a hump is a typical ethnic feature in
arab males in my country, I am convinced that
my nose in particular is far to big and too
broad. It appears almost African to me. I am
very self-conscious about this and would like
to consult with you during my next trip to
Munich in June. Please, doctor, help me! Thank
you, Mohammad
Dear Mohammad, thank you for contacting me
from long ways. I fully understand your
concerns and can assure you that you are not
alone: in the past I have treated many male
patients from your country and other countries
in the gulf area. Even though ethnic features
are to be considered particularly in
rhinoplasty, some patients simply have to big
of a nose and need plastic surgery.
When you come to my office,
I will demonstrate to you many before-after
pictures of other arab males and you will see,
that I did not change their looks but enhance
their looks. I set great effort in creating a
very natural result so that you see the
difference you always wanted but people around
you don't realize that you had cosmetic
surgery. Together we will - step by step - do
a computer simulation in order to determine
how much change you want and how this would
look. I can assure you that your final result
will closely match what we planned ahead of
time and that you will not end up like Michael
Jackson.
I am worried that my
looks may be changed too much by cosmetic
facial surgery and that I will not be myself
after surgery. Are my fears justified?
The goal of cosmetic facial rejuvenation is
not to cause extreme alterations of one's
appearance. This may be desired in the case of
severe congenital facial deformities. However,
age-related changes are desired to be removed
by most patients and only characteristics that
really annoy patients are really being
changed. Ideally, cosmetic facial rejuvenation
should result in that a positive change of the
patient's appearance is being recognized by
the personal surrounding, however, nobody
really can tell or dares to ask why this is
so.
Is there any treatment available for reducing
the the appearance of stretch marks?
This is a very common question and,
unfortunately, there is not a simple answer.
Treatment of stretch marks is somewhat a
function of where they are located. Some
people get stretch marks under the arms, many
get them on the abdomen after childbirth and
pregnancy, and patients of both sex get them
on various parts of the body after a
significant weight loss. Sometimes the stretch
marks can be eliminated by direct surgical
excision of the redundant skin, such as in the
case with an abdominoplasty
("tummy-tuck"). Many kinds of body
contouring procedures can be done to improve
the contour of the area, remove or minimize
stretch marks, albeit at the cost of an
additional scar from the surgery itself. Most
topical preparations for stretch marks are not
effective. Laser treatments or injectable treatments from
our experience don't seem to
improve stretch marks at all.
I live in Dubai and am very
interested in undergoing rhinoplasty during my
next trip to Germany in July. My nose is not very
bad but I am very self conscious about it. I
want to look my best. Can a rhinoplasty make a
difference when it is not extreme?
Rhinoplasty can really make a difference in a
person's facial appearance. The nose has a
very prominent position in the face and most
people are quite conscious about that. I would
encourage you not to feel you are being vain
about your appearance as I frequently see both
men and women who are concerned about the
appearance of their nose. It is difficult to
say what would need to be done in your
particular case without examining you. If you
have access to a digital camera or a scanner, I would
encourage you to email me some pictures of
your nose from the front, from the side, and
from the bottom with your head tilted back.
With those, I could give you a better idea
what the procedure would entail as I would
have a sense of what type of rhinoplasty I
might need to do. Please, consider to stay at
least 2 weeks in Germany after surgery, as the
healing process needs to be monitored by us
closely.
My friend from Kuwait City had a facelift in
Chicago last year. She is now very unhappy for
her unnatural looks. I am very interested in a
facelift in general, however, I am afraid that
I may look artificial afterwards as well?
We are confronted with concerns
like yours on a daily basis. We can assure you
that enhancing your looks - not
changing - is of utmost concern to us. The
perception of facial beauty is different in
American surgeons and European surgeons and
likewise in their patients. Dr. Michael Kremer
has trained in the US for several years and
from his experience puts great effort in
creating natural looks as - from your
long experience - requested by most patients
from Europe and the Middle East. We will show
you many before-after pictures during your
consultation in our office to further reduce
your fears.
What is the difference between cosmetic and
reconstructive surgery? I have had difficulty
with my insurance calling things cosmetic
which I do not think are really cosmetic.
Cosmetic surgery is performed to reshape
“normal” structures in order to improve
the patient’s appearance. Cosmetic surgery
is not covered by health insurance.
Reconstructive surgery is
performed on “abnormal” structures of the
body caused by congenital defects,
developmental abnormalities, trauma, defects
following surgical treatment of cancer, or
other diseases or difficult wounds. It is
often performed to improve function but many
of these operations are also done to improve
appearances as well. Reconstructive surgery is
usually covered by most health insurance
plans, although coverage for specific
procedures and the amount of coverage for
these procedures varies greatly between health
plans. Accident insurance policies often cover
the treatment costs for "cosmetic"
surgery after trauma.
There are several common
operations performed in plastic surgery that
are increasingly difficult to get covered by
insurance plans. Breast reduction is one of
these operations. Other procedures, such as
surgery to correct congenitally abnormal ears,
remove keloids or widened scars, or scar
revisions are additional procedures that are
difficult at times to get covered by insurance
plans. Please
contact your insurance carrier early ahead of
time. Our office will assist you in explaining
your individual situation to your health or
accident insurance, if necessary by a detailed
assessment and photo documentation.
Eventually, at least a partial coverage
agreement can be negotiated.
I am a 60-year-old woman with an excellent
complexion (peaches and cream) and excellent
facial circulation. Unfortunately I have developed some jowls and some sagging. Would a
face lift negatively affect my complexion and
facial circulation? It would seem that
undermining the skin might harm capillaries,
some of which might not reconnect.
Typically a facelift does not have an impact
on a patient's complexion and skin quality.
The capillaries that supply the facial skin
lie in the dermis, which is not altered during
this procedure. If you are
considering a facelift and a are concerned
about your skin, we would - after a thorough
personal consultation and examination - suggest that
you see the aesthetician on our team, who might
start you on a medically supervised skin care
program.
Have you ever known anyone to have had
silicone breast implants for more than 30
years? How long do silicon implants last?
The question as to how long silicone implants
last is often asked and the answer is unknown.
There are many women who have silicone
implants that are 30-40 years old but we
cannot really say how much longer they are
going to last. The implants utilized at that
time are not the same as those currently being
utilized. We do believe that each year the
implant technology improves and the implants
we are using now are clearly better than they
were 20 or even 10 years ago. The advice we give to
our patients who have silicone implants
is to get yearly mammograms, which are
probably indicated for early cancer detection if the patients are over 40
anyway, in order to detect any pathological
changes.
If
you seriously consider breast augmentation, we
will be happy to go over further details of
this rather confusing matter with you during
our personal consultation and you will be able
to see and feel different kinds of implants.
I am from Abu Dhabi and plan on visiting
Germany this summer. After I am thinking a lot
about breast reduction surgery, I would like
to ask you what method you use at your center for reduction
mammaplasty? If you use more than one
technique, what would determine which
technique would be best for the patient? Do I
need to bring preoperative tests from here?
The approach used by us for breast reduction varies
and is based mostly on the size of the patient's
breasts, the amount desired to be removed as
well as the patient's tissue quality. We use
several different technique and personally
favour periareolar and vertical
mammaplasty approaches, designed to decrease
the amount of scarring, to maximize blood supply to the nipple and
minimize the risk of damaging sensation to the
nipple. However, if a large reduction of
breast tissue is necessary, an inverted T-scar
will remain, that fortunately for most cases
hides nicely below the breast fold and is
generally accepted by patients for the
trade-off.
For
your own safety, we require each patient to
undergo a mammography before surgery and the
removed breast tissue is being sent to
pathology to rule out any forms of so far
undetected breast cancer. We are cooperating
with well respected and well equipped
radiology centers and can arrange for the
necessary preoperative diagnostics here so
that you do not need to undergo these tests in
Abu Dhabi. We look
forward to seeing you this summer! Please,
arrange to stay around for about 3 weeks after
surgery to that we can make sure that the
healing process is o.k. before you return to
the UAE.
I am 28 years old and have had 3 pregnancies. I am
very interested in a tummy tuck. I have tried
several ways to lose weight and tighten my
stomach, but nothing works. It has been
several years since my last kids and my weight
has stayed stable. I know that I am not fat,
but I am bothered by my stomach. The only
thing that I am worried about is a scar.
What type of tummy tuck you need is very much
a function of what is causing your excess
abdominal size. Patients who have excess skin
and fat may need to have the skin and fat
simply excised. If there is underlying
weakness of the abdominal wall or separation
of the abdominal wall muscles, abdominal wall
work would be needed as well. This is
particularly common in mothers following
giving birth and may be the case in your
particular situation as well. The length of
the scar is really a function of how much
excess skin and fat you have. If there is a
great deal of excess tissue, particularly
toward the sides of the abdomen, then the scar
will need to be quite long. I try to determine
the course of the resulting scar with my
patients preoperatively as detailed as
possible and - if desired - hide the
scar within the so called "bikini line".
All body
contouring surgery, unfortunately, involves
trading scar for improved contour if there is
excess skin or fat that needs to be excised.
Dr. Kremer, I have been considering breast
augmentation surgery for quite a while and
have a question: do you ever do the armpit
insertion, if a patient is suitable. I wish to
preserve as much nipple sensation as possible
and dislike scars around the nipple. I am 42.
Is this too old? Thank You!
Breast augmentation in a 42-year-old is not an
uncommon procedure. As patient's age, their
breasts become more ptotic (droopy) and
sometimes an additional breast lift needs to
be done.
I
personally prefer the armpit approach due to
my good personal experience with this method
while working in the US as this leaves only an
almost invisible scar behind. I almost always
use saline-filled prostheses that are being
placed underneath the pectoralis muscle.
Permanent sensation changes of the nipple
hardly ever occur with this method.
The
information on this web site is only intended
as an introduction to this procedure and
should not be used to determine whether you
will have the procedure performed nor as a
guarantee of the result.
The
best method of determining your personal
options is to schedule a personal consultation
with Dr. Kremer. He will be able to answer
specific questions related to your situation.
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