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101 Old Short Hills Road Ste 510
West Orange, New Jersey 07052
973-736-5907

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Monthly Archives: July 2012

Best Docs in New Jersey

New Jersey Monthly Interviews Dr. Spiro for Best Doc

The following comes from an interview done by a magazine for a Top Doctor’s issue.   We will present 5 questions and answers each week for 3 weeks.  Enjoy.

1. What is the philosophy of your practice?

To develop a thoughtful plan by listening to the patient, evaluating with a critical eye, then use my art background combined with surgical expertise and experience to deliver the highest level outcomes in a caring, personalized, and friendly environment!

2. Please explain what it is that you do.

I look at the body as living art.  Sometimes a patient is depressed about their appearance.  I’m like the sculptor starting with a block of stone.  Everyone else sees the block, I see the final beauty.  My job is to get to that point with people.

 3. Discuss your approach to patient care.

Individualized management.  No two people are exactly alike.  No two plans should be the same.  Make every patient feel unique.

 4. Is there a cutting-edge treatment or procedure that you want to highlight?

It’s about philosophy and principles first and foremost. The body must be looked at three dimensionally.  You must develop an artful plan and have the skill to execute.  True plastic surgery excellence comes from the application of these principles not from any cutting edge anything… ever…

 5. What differentiates your practice from others?

I want my patients experience with me to be unmatched and unrivaled.  I want them to know that on the day of surgery (for example) together with pre-op planning and post-op care that there was no one anywhere who could have put forth a more personal and sincere effort on their behalf.

Click here to read the first 5 questions.

Breast Augmentation Characteristics

The seven characteristics that go into breast augmentation

So now we are on to the second characteristic that we can select regarding breast augmentation. Implants are covered in a shell. This shell can be made with a smooth surface or a textured surface. The available textured surface is slightly different between the two dominant manufacturers. Texturing the surface was initially thought to combat the occurrence of capsular contracture – or hardening of scar around implants- but I believe this to be untrue. I believe capsular contracture is partly a function of implant location. Years ago, all implants were placed over muscle or within the gland. This promoted contracture. Since nearly all implants back then were smooth surface, it was assumed that the smooth surface caused the contracture. WRONG!

I feel that texturing the surface increases implant malposition which is the number one reason for re-operation. It introduces another variable to healing and this is not smart. So I recommend smooth surface for happier breasts and happier patients!

Click here to read about the 1st Characteristic

Best Docs in New Jersey

New Jersey Monthly Interviews Dr. Spiro for Best Doc

The following comes from an interview done by a magazine for a Top Doctor’s issue  We will present 5 questions and answers each week for 3 weeks.  Enjoy.

1. Are there other doctors in the practice to mention?

No

2. Where did you receive your medical training?

Medical School:  University of Medicine and Dentistry of New Jersey (UMDNJ), New Jersey Medical School, (1984 – 1988)

Residency: General Surgery (1988-1993) St. Barnabas Medical Center, Livingston NJ

Plastic Surgery (1993-1995) University of Miami – Miami,  Florida

Fellowship:  Plastic Surgery (1995-1996)University of Miami and Miami Children’s Hospital – Miami, Florida

3. What is your specialty/subspecialty/areas of expertise for the practice?

  1. Breast and Body Contouring including: Breast Augmentation, Breast Lift, Breast Reduction, Tummy Tuck and Liposuction
  2. Facial Aesthetic Surgery including: Face-Lifting, Eyelid Surgery, Rhinoplasty
  3. Breast Cancer Reconstruction

4. What hospitals are you currently affiliated with?

St. Barnabas Medical Center, Livingston NJ

5. How long have you been in practice?

I am entering my 17th year in practice.

Breast Augmentation Characteristics

The seven characteristics that go into breast augmentation

I’ve been told I have a knack for being able to simplify things. So here I’ll make it simple to understand the subtleties of breast augmentation.  There are essentially 6 characteristics that can be changed or decided upon. Each week I’ll go over one new one. In six weeks you’ll be an expert!

First, is implant fill. Implants can be filled with only two substances, either silicone gel or saline. There are several different types of silicone gels available today. Suffice it to say, they are all versions of cohesive gels, but “gummy bear” refers to the most cohesive of the gels. To me they are oddly firm, and I don’t love them.

Since gravity has a significant unavoidable influence on any fluid filled body, it has been my observation that silicone gel filled implants (memory or cohesive ) tend to provide patients with longer term aesthetic predictability than saline filled implants. This is due to torso and rib shape curvature, as well as the water hammer effect over time from saline.

If you lived under water or on the moon it wouldn’t matter, but here on earth, silicone filled implants migrate less over time and have less rippling. Just the facts.

No implant lasts forever. If you factor in all the things which lead to re-operation, I believe silicone filled implants lead to less numbers of surgery for patients over their lifetime.

 

Rhinoplasty

Natural Nose Job

I don’t know, but to me just that lingo; “nose job” has negative connotations.  The overdone DONE nose to me is an eyesore of eighties and nineties plastic surgery which should be banished for eternity.  The cookie cutter nose works on some, but not on most.  It takes less effort of thought and less work in surgery to deliver that nose, but at what expense.  Nowadays it seems people want their noses to look more normal.  The nose should fit the face.  Rhinoplasty should craft a nose which sits in harmony with its surroundings.  So if all you see of someone’s face before rhinoplasty is a big or wide or crooked or ugly nose you would not end up with a case of, all you see after rhinoplasty of a person’s face is a malfitting overdone nose job.

So design the surgery to make it blend in. Natural looking noses are more appealing.

Food for thought….

 

Facelift

Natural Look Facelift

I had hoped we’ve grown away from the windblown over pulled look characterized by so many face lifts done in the eighties and nineties. But sadly, we all can still see these faces everywhere. Sometimes they are as a result of a cookie cutter approach, and sometimes they are from over pulling the skin to compensate for under dissection of the deeper tissue planes that contribute to sagging. Nevertheless, the outcomes to me are suboptimal. Excessively tight pulled faces have skin which looks shiny and it tends to flatten the face. Flattening ages the appearance. Youthful faces have volume right?

Excessive pulling causes odd pull strains which set up as strange lines across the face. In my estimation, people want to look younger, not more strange. At least most people anyway!

We all are guilty of gently pulling our skin back across our cheeks and neck in a horizontal motion as we look into our mirrors! It probably happens countless times a day across America, but this is not how surgeons need to correct facial aging. There-in lie’s the trap. The face ages complexly, so the corrections can’t rely on one force to make change, and that is where weird outcomes stem from.  For example using “Threads” to tug on the undersurface of the skin, or doing a “skin only” lift. The corrections have to take into account the many levels of aging, problem is that there are anatomical considerations of where facial motor nerves run which prohibit certain things from being done. So knowing that surgeons must compromise for patient safety of outcome we have devised approaches which satisfy most of the requirements.

The face, including the eyes, age in pockets. We have areas of good adherence and areas of poor adherence. Well adhered areas stay fixed to underlying tissues. Poorly adherent areas sag.  The sagging progresses to the next fixed point. The interface between lower eyelid skin and cheek skin is one example. The nasolabial fold is another. The jowl is a third. Restoring these to their youthful location and adding back volume to some faces at the same time is the solution.

There are many fancy words to describe the numerous techniques out there. “Composite lift”,   “DUAL PLANE”, are just some of them.

My approach is simply this.

1-      Make a proper diagnosis. What really is happening to that face?

2-      Listen to the patient. What are they trying to achieve?

3-      Design a plan. Do they need volume added and where? Should it be fat grafting or filler? Combine this with a good extended “SMAS” face lift and extended skin undermining without extensive pull.

4-      Execute the surgery well

5-      Have patients agree to a long term skin surface replenish program with products and light periodic peels

And there you have it. A primer on plastic surgery of the face!

Best of luck!

Regeneration
Promises to fill the needs of our patients who are seeking non-surgical facial & body regenerative skin care.