Some say JLo had “it” done, maybe Kim Kardashian too. “It” being a glutal augmentation with buttock implants or the famous Brazilian Butt Lift (which – like facelift – is on the road to become another big misnomer in the history of cosmetic surgery.
Attractive breasts, bellies and buttocks rank high among the markers of femininity in our Caribbean and International plastic surgery and cosmetic surgery practice at Trinidad Institute of Plastic Surgery, Trinidad and Tobago. Clients from all over the Caribbean – Barbados, Jamaica, Guyana, Venezuela, St. Vincent or Bahamas ask for it every day.
In the context of breast augmentation, tummy tuck and gluteal enhancement bigger is not necessarily better, it is the shape of the breasts, torso or buttocks and their natural harmony that makes it or breaks it. This is a fairly straightforward conclusion – just look at the next big butt you see on the street and ask yourself if it has an attractive shape in harmony with the remaining body.
This conclusion implies then that there must be an aesthetic ideal with respect to the size and shape of the buttocks (with some cultural variations – rather petite in Asians, rather moderate in Caucasians, wider in Latinas, more projecting in Afro-Caribbeans, East Indians being somewhere in the middle, often surprisingly close to Asians/Caucasians in their preferences) and in fact there is, much as there is an aesthetic ideal for breasts.
While breasts and abdomens can be relatively reliably reshaped at Trinidad Institute of Plastic Surgery with implants, lifts, fat transfer, liposuction and lipoabdominoplasty, gluteal augmentation eluded plastic surgeons for quite some time as buttock implants (first idea that came to mind) in their early days unlike breast implants were quite devilish devices with a ridiculously high complication rate. This situation has somewhat improved over the past couple of years with improved devices outside the US and a better understanding of appropriate surgical techniques.
Buttock implants are best used in buttocks close to the aesthetic ideal, which just lack projection when viewed from the side. This is again similar to the use of breast implants, which are employed to enlarge small but otherwise aesthetically ideal breasts. Buttock implants do not lift the buttocks much if at all and only moderately improve the shape by taking care of the absent projection. With other words, they are somewhat one dimensional.
So when would a buttocks lift be advantageous ? Well, again similar to breasts lifting, a buttock lift is an option if the buttocks sag (here as well the medical term is ptosis). Unfortunately the analogy continues – breast and butt(ock) lifting require incision and excisions leaving scars. True buttock lifting in our own practice at Trinidad Institute of Plastic Surgery is most often required to correct the effects of aging in the 60+ age group and after massive weight loss. In the latter group it is mostly performed as part of a lower body lift.
The ongoing analogy was ingeniously broken by Brazilian plastic surgeons, who designed another procedure besides lipoabdominoplasty truly for the 21st century – the Brazilian Butt Lift, which has nothing to do with lifting the buttocks but everything with rehaping them. Much like Michelangelo saw the sculpture and not a the block of stone in front of him, gluteal reshaping with the Brazilian Butt Lift means approximating an aesthetic ideal by taking off what is too much with liposuction and augmenting what is too little with fat transfer – gluteal sculpting. In general no incisions beyond the access for liposuction and fat injections and excisions are required except maybe Mendieta’s small Miami thong lift incisions hidden in the gluteal crease and folds. The risks are minimally increased over a standard liposuction of less than 4L aspirate. While gluteal sculpting has an increased operating time compared to buttock implants it is still within reasonable limits if appropriate fat harvest and transfer technologies such as those available at Trinidad Institute of Plastic Surgery are used. Due to the use of the body’s own fat the results are a very natural “look and feel” with a recovery time similar to a large outpatient liposuction.

Warning – looks great in swimsuits !

contact us to start the journey.

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Gynecomastia (male breasts, male breast enlargement) is a benign proliferation of breast tissue in men. Gynecomastia (male breasts, male breast enlargement) is a surprisingly common problem in our Caribbean practice of Plastic Surgery and Cosmetic Surgery at Trinidad Institute of Plastic Surgery – between 4% and 69% of teenagers in puberty and 32% and 65% in adult males, depending on the author, suffer from excess of breast tissue. Clients from many of the surrounding Caribbean islands (Barbados, Jamaica, Haiti, St. Vincent and the Grenadines, St. Lucia, Granada, Martinique) and surrounding countries (Guyana, Venezuela) have come to Trinidad Institute of Plastic Surgery to have this often vexing problem taken care of.
The cause of gynecomastia (male breasts, male breast enlargement) is a relative or absolute imbalance between estrogens and androgens during puberty, which favors the growth of breast tissue stimulated by estrogens. This phase of growth usually lasts anywhere between 1-2 years. At the end of puberty follows the phase of fibrosis, where more and more breast tissue is replaced by connective tissue. Fibrosis in gynecomastia (male breasts, male breast enlargement) also implies irreversibility: The fibrotic tissue is less responsive to hormones. Thus even with a clear preponderance of androgens improvement in the appearance of gynecomastia (male breasts) is minimal – without surgical treatment it is and remains too large.
In a certain percentage of clients the hormonal imbalance is due to an underlying cause, especially internal medicine problems (liver disease, kidney disease, thyroid disease, certain medications), lifestyle habits (alcohol, marijuana) or in rare cases, the male breast enlargement is sign of an underlying tumor (hormone-producing gonadal or adrenal tumors or breast cancer in men) .
Gynecomastia (male breasts, male breast enlargement) should therefore at least be subjected to scrutiny with respect to the possible causes. Whether it will then be operated in the event of idiopathic gynecomastia (no underlying cause found) in adults remains the decision of the client. Adolescents during puberty have a good chance that with the end of puberty gynecomastia (male breasts) will come to an end as well without further surgical therapy.
The surgery for the correction and treatment of gynecomastia (male breasts) depends on the severity of the problem, like so many other issues in plastic surgery. My standard operation (and also those of many other plastic surgeons) consists of a combination of direct excision of the fibrotic breast tissue and liposuction to equalize the tissue thickness of the area under the nipple (now devoid of most breast tissue) to the rest of the chest wall. The small incision around the lower half of the circumference corresponds to the so called periareolar incision used thousands of times per day worldwide for breast augmentation in women and in my experience heals very well in African-American, Caribbean and Indian dark skin types, and virtually never represents a problem in fair skin types such as Caucasians or Asians. In about ten percent of my clients is gynecomastia (male breasts) so large that a formal breast reduction much the same way it is done in women becomes necessary to reduce the skin envelope at the expense of correspondingly longer scars. Alternatively, sometimes a combination of direct excision with liposuction can be attempted with a concomitant level of uncertainty (will the skin retract enough ?) but potentially shorter scars.
Like many other cosmetic / aesthetic surgery procedures, treatment of gynecomastia (male breasts, male breast enlargement) results in high client satisfaction, improved body image and psychological well-being.

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Trinidad Institute of Plastic Surgery’s website www.caribbeanplasticsurgery.net has become the number one ranked English language website for numerous cosmetic, aesthetic and plastic surgery related keywords, topics and searches in the Caribbean. A review conducted by Bioengineering Associates LLC, our US based management company, revealed that a little more than two and a half years after first going live Trinidad Institute of Plastic Surgery’s site www.caribbeanplasticsurgery.net ranks number one for search terms such as  ”cosmetic surgery caribbean” or “plastic surgery caribbean” on multiple global search engines such as Google, Yahoo and Yandex and is on the front page for extremely competitive keywords and phrases such as “breast augmentation caribbean” or “tummy tuck caribbean”. Trinidad can do it !

At this point, our thanks to all our website vistors, new and returning, the excellent web designers at Bioengineering Associates, Dr. Schleich (Chief of Plastic Surgery) for his numerous content contributions and Bluehost for a 99.99% uptime and availability.

Naleenie Singh-Maharaj, RN, BSN, CCRN, TNCC, MHSA, MBA

CEO, Trinidad Institute of Plastic Surgery

We are pleased to announce the availability of our new plastic surgery and cosmetic surgery forum on the Trinidad Institute of Plastic Surgery website.

The forum is moderated by Trinidad Institute of Plastic Surgery surgeons and physicians and intended to facilitate the discussion of plastic surgery and cosmetic surgery related topics.

Registered members of Trinidad Institute of Plastic Surgery are able to post on the forum, which also features a closed, private mailing system.

We see this enhancement as an opportunity to improve the user experience provided by our website and also facilitate interaction with our clients.

Naleenie Singh-Maharaj, RN, BSN, CCRN, TNCC, MHSA, MBA

CEO, Trinidad Institute of Plastic Surgery

Trinidad Institute of Plastic Surgery is proud to announce to availability of a multimedia telemedicine, virtual conferencing and virtual consultation service starting February 1, 2012.

The system made available by Bioengineering Associates, our US based management and healthcare consulting company, allows voice, video and chat interaction through a virtual private network server.

It is intended to provide patient and physician access to highly trained specialists in plastic surgery, hand surgery, burn surgery and craniofacial surgery with otherwise limited availability in Trinidad and the Caribbean. Telemedicine is expected to make a major impact on healthcare delivery in this decade.

In the initial phase Dr. Schleich, Chief of Plastic Surgery, Plastic, Hand, Craniofacial and Burn Surgeon, and Dr. Ramkissoon, Chief of Anesthesia and Specialist in Pain Management, will be available for interaction on this system.

Scheduling is possible on a 24/7 basis through Trinidad Institute of Plastic Surgery Global Access.

Naleenie Singh-Maharaj, RN, BSN, CCRN, TNCC, MHSA, MBA

CEO, Trinidad Institute of Plastic Surgery

So Pandora’s box was finally opened. The eventual worldwide recall of French Polyimplant Prothese (PIP) silicone breast implants puts a final exclamation mark behind what everybody knows but hates to admit – cheap is bad, to be cheap you have to cut corners to cut costs and cutting corners – such as using industrial instead of medical grade silicone (besides other substandard manufacturing practices such as inferior easily ruptured shells) – costs in the end.  An estimated 300000 women were implanted PIP silicone implants, mainly in countries with low level of medical care and deficient in plastic surgery training and acumen, such as Venezuela, Belgium, Poland, Czecheslovakia etc. It doesn’t stop in third world and quasi third world countries. UK surgeons  allegedly succumbed about 40000 times to the same error, French surgeons around 30000 times and Australians, Austrians and Germans line up right behind to match the price of their competitors down the road or across the border.

Like a knee jerk reaction comes the desire to blame somebody after the company PIP is not any longer available to take the fall having gone to bankruptcy  heaven months ago. What I am going to say now will not be popular, like any truth. No single entity is to blame, it is everybody’s and thus nobody’s fault.

Regulatory oversight  according to European Community standards over the manufacturing of a high risk medical device failed miserably. Nobody noticed for years that this crap did not conform any longer to the CE specifications and European Medical Device Directive ? Give me a break. Want to sue somebody over PIP implants – these are the people to start with wanting the company itself as a primary culprit. Without the CE label the device could not have been used legally in the European Community and close to 100000 women would likely have been spared the fate to agonize over the decision what to do now.

Blame the surgeons – always popular, and at least in this case partially correct. Any surgeon naive enough to make him or herself believe there is no difference between an implant costing around 200 USD per pair and one costing around 1500 USD/pair should voluntarily stop practicing because this degree of stupidity might affect all decisions he or she makes. But according to the CE label the 200 USD/pair joke was at least harmless, as this is what the CE label essentially means. It signifies safety, not much more, particularly does not imply any effectiveness. So in the mind of the naive a safe device was used, no less.

Now very unpopular – the consumer may have some responsibility for his/her decisions. You get what you pay for, literally, that is the essence of consumerism.  Cosmetic surgery is a luxury good and it has the price tag of a luxury good. Anything cheaper means corners have to be cut. Properly trained plastic surgeon, experienced, certified by a reputable specialty board (no, not the one in Santa Somewhere), with enough training, experience and judgment to know the difference between a good and a cheap implant, high end implants and equipment, respected hospital, first class anesthesiologist – all are on the same level as German luxury cars. And those don’t come at a price of some bamboo cart held together by dried spit, just ask your local dealer.  So no, the consumer was not cheated, consumers did what they do best, consume based on the number on the price tag of the good they desire, short sighted to what that number actually means. Consumers, who do not look beyond that number, will always get what they pay for, particularly in cosmetic surgery.

So what now – after all PIP implants may result in health related  problems ?

If there is any clinical evidence of  device failure, explantation or exchange are the only two options, like for any ruptured silicone implant regardless of the manufacturer. In my opinion explantation is aesthetically unfavorable, but the desire of the client should certainly take precedence. Without clinical evidence of device failure a more difficult situation arises. The options are watchful waiting, watchful waiting with imaging surveillance to screen for silent rupture (as mandated by the FDA for Allergan/Mentor silicone implants in the US) or prophylactic exchange/explantation of any and all PIP silicone breast implants. The speculation of French health authorities that breast cancer risk in women with PIP implants may be increased contradicts all biologic knowledge about silicone, is not substantiated by their data at the present moment and may not be a valid argument for prophylactic exchange/explantation at this time.

When data is lacking, opinion is abundant – so here are my five cents:  a woman having PIP implants obviously has a substandard device implanted, which will likely have to be exchanged or explanted at some time, even in the absence of clinically evident rupture at present. If the personal health related concerns of the woman are high enough I would advise exchange of implants for a high end device such as Polytech, Silimed, Mentor or Allergan. Explantation alone should be performed if the client is clear about the aesthetic consequences and absolutely does not desire implants any more.

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View Healthgrades for Dr. Schleich here. Healthgrades is one of the better organized and objectively reviewed rating organizations in the US.

Dr. Schleich performed plastic surgery on me in early 2011, which comprised decompression of multiple nerves in the craniofacial region, reshaping of my skull as well as septo and rhinoplasty. While being done with techniques used in cosmetic surgery, the primary purpose of the entire procedure was to relieve my severe migraine headaches. I had been suffering for 17 years on a nearly daily basis from severe and sometimes incapacitating migraine attacks. I had been on various chronic medications to suppress the severity and frquency of those migraine headaches. Dr. Schleich had performed botox injections into several trigger points previously and I experienced significant, but temporary relief of migraine from botox. Dr. Schleich thus considered me a good candidate for the surgery. Dr. Schleich’s skill and professionalism are amazing. He is extremely honest about what the possibilities are as far as surgical outcomes. I felt confident that I would be in good hands, and now almost a year after surgery, I  am happy to report that I was absolutely right. My migraines have been relieved by more than 90%, and Dr. Schleich provided the best care I could possibly have imagined before, during and after the procedure. I have thanked him repeatedly, and do so again!

The consultation is an indispensable preliminary for everything else. It establishes the framework for counseling and the exchange of medical information – the famous benefits, risks and alternatives for any treatment. Cosmetic surgery is mainly the change/enhancement of parts of the human body. This is highly individual and has to be analyzed at least by “look and feel”, sometimes in more depth. So the client really has to meet with me. The only exception I make to this rule is for my international clients, where a phone consultation with pictures of the area where correction is desired is conducted prior to the client coming to Trinidad. This minimizes the surprises and possible disappointments in our experience and to date I have not yet been forced to change the operative plan based on findings at the preoperative visit that were not apparent during the phone consultation. But I am sure there is going to be a first here, too.

“Before treatment the gods have put diagnosis” – I forgot who said that, but it is an immutable truth. Without making a correct diagnosis the correct treatment plan cannot be formulated. At the consultation the analysis of the problem results in a diagnosis. From the diagnosis the possible treatments follows logically. A popular example is breast augmentation – sagging of the breasts to the degree incompatible with the placement of implants (even very projecting ones) has to be diagnosed as the treatment then becomes a lift, possibly with an implant. A close runner up is liposuction of the torso – areas of skin laxity and overdistension or underlying muscular changes in the abdominal wall should be treated differently than mild excess adiposity in the belly with tight muscles and skin for optimal outcomes, no matter how much “research” or “reading online” is done or what the friends say. Consciously choosing a suboptimal procedure despite having been educated to the contrary is certainly an option for a variety of reasons (cost, convenience, scars etc.) and it is part of the counseling and education aspect of the consultation to ponder upon the various trade-offs. As I am a perfectionist I occasionally reject performing suboptimal procedures, particularly if the likely result and the understanding of trade-offs exhibited by the client are to far off for my taste.

Once the treatment/procedure are determined it makes sense to talk about cost. Neither my office staff nor myself can give information about cost over the phone prior to completing a consultation. For the hypothetical “average procedure” hypothetical “average surgical fees” are posted in the cosmetic surgery price list, regardless of the applicability of the procedure to an individual situation. Anything more specific or detailed can only be done during a consultation.

So the answer to “What is the cost of … ?” is “Initially, everything costs the same – the consultation fee”.

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