Who Needs Drains? The Drain Less Tummy Tuck Is Here to Stay!

October 31, 2017 sieberps

If you’ve been considering a tummy tuck or mommy makeover, it is very likely that you have come across information about drains during your research, or saw photos on RealSelf or Instagram show patients after tummy tucks hauling around their drains. Well those days are gone! If you’re thinking about getting a tummy tuck but don’t like the idea of drains, then keep reading!

For many procedures, surgeons commonly put temporary drains in to collect fluid which may accumulate under the skin after the surgery. The reason they do this is because the body does not like to have spaces filled with air, so instead it produces fluid to fill that area. Anything that is removed from the body, whether it’s a lung or some fat, is immediately replaced by fluid to fill in the empty space. Most of the time the fluid just occupies the space until the body is able to remove it and replace the fluid with scar tissue during the healing process. Sometimes there is too much fluid for the body to remove quickly and it gets trapped in the tissue resulting in something called a seroma. A seroma is simply a collection of fluid the body placed there to fill a space during the healing process. To avoid this from happening, surgeons started using drains to collect excess fluid so that it didn’t get trapped underneath the skin. Having drains works great for removing unwanted fluid, but they are a bit of a nuisance for the patient!

In order to reduce the amount of space left after a tummy tuck, something called a progressive tension suture (or quilting sutures) was invented. This suture acts like an internal tuft and results in less space into which fluid can collect. In most patients, when these progressive tension sutures are used during a tummy tuck, drains are no longer needed. Studies have shown that by adding these sutures, the incidence of seromas is drastically reduced whether or not drains are used.

Putting in the progressive tension sutures does add a little bit of time to the surgery, but in my opinion the benefits are worth it. The progressive tension sutures can also be placed in a very precise fashion to re-create the peaks and valleys of an aesthetically pleasing mid-section!

So if progressive tension sutures are so good, why are so many surgeons still using drains? This is in part is because surgeons tend to operate in ways that they feel are most reliable and predictable, and are slow and cautious to implement new techniques. I believe that it is important to be at the forefront of medicine and to adopt proven techniques which have been developed to improve the recovery process and optimize the surgical outcome.

If you’re thinking about getting a tummy tuck or a mommy makeover, ask if you’d be a good candidate for a drain-less tummy tuck. For more information or to schedule a consultation give us a call at 415-915-9000.

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Do Breast Implants Cause Cancer?

October 17, 2017 sieberps

The short answer: possibly, but the long answer is much more involved and not nearly as simple.

Although breast implants have been around since 1961, it wasn’t until 1997 that a woman was found to have developed a rare lymphoma called anaplastic large cell lymphoma (ALCL) related to her breast implants. Today this lymphoma is called breast implant associated anaplastic large cell lymphoma (BIA-ALCL). Reports in the recent media of breast implants causing breast cancer are referring to BIA-ALCL, not related to primary breast cancer. It’s very important that patients understand the difference between BIA-ALCL and breast cancer as they are two totally different entities with very different prognosis and treatments.

There are several factors which make the two cancers very different. The first is that because BIA-ALCL is a lymphoma, it is a disease originating from the immune cells in the body and not from the breast tissue.

To date there have been a little over 300 reported cases of BIA-ALCL worldwide in over 50,000,000 women with breast implants and they all have one thing in common: they all had breast augmentations with textured breast implants. As far as we know there has never been a case of BIA-ALCL in a woman who had smooth breast implants. So, what is it about textured breast implants that makes BIA-ALCL only occur in those patients? We believe the texturing on the breast implant allows for bacteria to hideout within the nooks and crannies within the silicone shell. Bacteria is smart and it knows that as soon as it’s in the body, the immune system will be looking for it. So is does something very unique, the few bacteria cells make a covering over the cells called a biofilm. This biofilm acts like a barrier between the bacteria and the immune system. So even though the body knows the bacteria is there, despite its best efforts, it can’t get to it to destroy it. What happens over time is that the normal immune cells get frustrated trying day and night to get to these bacteria so the immune cells mutate. This mutation then prevents the cells from acting as they normally do and over a long period of time can eventually lead to the formation of a lymphoma. Most women presenting with BIA-ACLC have had breast implants for 10-15 years before any symptoms appeared because the cellular transformation takes a very long time.

The promising news about BIA-ALCL is that it is a very treatable disease. Current studies recommend removing the breast implants as well as the capsule around the implants. This procedure is curative in the vast majority of cases.

So what is your actual risk of dying from BIA-ALCL if you have textured breast implants for your entire life? In order to understand this question we need to introduce a term called a micromort. 1 micromort is a 1 in a 1,000,000 chance of dying from a certain activity. The concept of micromorts was originally developed to help evaluate high risk activities such as mountaineering or skydiving, as well as other common everyday activities. For instance, drinking 0.5L of wine, living 2 days in NYC, riding a bicycle for 17 miles, riding in a car for 230 miles, or traveling by plane for 1000 miles all increase your risk of dying by 1 micromort. In terms of BIA-ALCL, the micromort risk for a woman with bilateral breast implants over her lifetime is only 0.4 micromorts. That means you’re 5 times more likely to die every time you drink a bottle of wine or every 4 days you’re in New York city than you are from BIA-ALCL related to textured breast implants!

So the short answer is although there are reports of breast implants causing cancer, the incidence of BIA-ALCL is extremely low and if a woman is diagnosed early, the disease is very treatable.

For more information on BIA-ALCL please read my article in the Aesthetic Surgery Journal as featured in Allure and Refinery29 entitled “What’s your Micromort? A Patient-Oriented Analysis of Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL).”

For more information on breast implants or breast augmentation surgery, give us a call at 415-915-9000 or send an email to

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Top Tips for Reducing Scarring After Plastic Surgery

October 16, 2017 sieberps

One of the biggest fears expressed by patients is the appearance of scars after plastic surgery. Unfortunately, we haven’t yet figured out a way to perform scarless surgery! Whether you’re having a procedure with tiny incisions like liposuction, or a more involved procedure like a tummy tuck, there are a few different things you can do to make sure you end up with the best scars possible.

What causes scarring? Skin is a seamless organ, so when there is damage to it, scars form as your body attempts to heal from the trauma. After your procedure, cells called fibroblasts come into the area and lay down new collagen (yes, the same collagen we want in our faces to tighten the skin!) to heal the tissue. Right after the procedure, your body relies on the strength of the sutures used to hold the tissue together. As time goes by and more collagen is placed, your incisions gain more strength and the sutures dissolve and disappear. Once the scars are formed, your body then goes through and organizes the collagen that was placed. This process can take up to a year, so be patient!

Here are the main things which determine how you will scar after surgery:

How well your surgeon closes your incisions
Plastic surgeons are known for their skill for meticulously closing incisions. This careful attention to each suture placed, will ultimately influence your final result. I make sure to leave you with the best incisions possible before leaving the operating room.

How your body naturally heals
Some people are just blessed with better genetics than others. You probably know by now whether you scar badly or not. Unfortunately, this part of the equation is largely out of your control and is based on the genes you were born with. If you’re someone who forms keloids or hypertrophic scars, which form when scar tissue grows excessively, that’s ok because the next section will address other steps which can help improve scarring in everyone.

What you do to care for your incisions after surgery
This is probably the most important sections as it contains information on what YOU can do to improve your scars.

The MOST important aspect for improving scars is avoiding UV exposure to your incisions for 1 year after your procedure. As the sun contacts your healing skin, the body does not know that the pigment produced is supposed to be there temporarily. What happens is the body builds the pigment procedure within the skin into you scar, leaving you with a dark pigmented scar. That is why it’s extremely important for you to either use a sunscreen with an SPF of at least 30 or keep your incisions covered for the first year. If you’re going to be outside, sunscreen should be reapplied every 2 hours.

All of my patients are placed on a scar therapy program after surgery. This is a must! The main component of this program is silicone. Silicone gel and silicone sheeting has been clinically proven to reduce the amount of scarring resulting from incisions. The most basic scar therapy should include at least 3 months of a silicone based gel which you will apply to your incisions twice daily. I recommend that patients continue using the gel for one year after surgery for the best possible results. A more advanced scar therapy program utilizes silicone sheets which are first applied two weeks after surgery and left in place for a 12-day cycle. A total of 5 cycles is needed to complete the entire process. Once the silicone sheets are no longer needed I transition patients onto the silicone gel for a total of a 1 year treatment.

Many patients ask about products like Mederma, Vitamin E, and other creams and lotions. None of these have been scientifically proven to help with minimizing scarring like silicone based products have, so don’t waste your money!

If you’ve already had surgery and don’t like the appearance of your scars there are still many options to improve the appearance. I utilize intense pulsed light (IPL) treatments to remove pigment and redness from the scars. Lasers, like Halo or Profractional, may also be used to improve scar texture and color. As a last resort, larger scars can be excised and reclosed, and using the methods above, you should be left with a finer more inconspicuous scar.

To make an appointment or if you have other questions about scar therapy, make an appointment at our San Francisco office today 415-915-9000.

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Understanding Your Facial Rejuvenation Options

September 14, 2017 sieberps

Every impression we make on the world begins with the face. Loved ones look into our eyes to better understand who we are. They grow to treasure each expression, the familiar curve of our smile, the eyebrow raised. Even strangers can often catch a glimpse of our personality with a passing glance.

At Sieber Plastic Surgery, we believe that the health and beauty of your face is always worth preserving. From seasonal-specific skin care to treatments and surgical operations, there are a variety of ways to care for your most defining characteristic.

Minimally-Invasive Treatments

Fortunately, intensive skincare does not have to mean invasive or harsh procedures. At Sieber Plastic Surgery, we have several minimally-invasive ways to rejuvenate your facial canvas. The treatment that is right for you will depend on your specific aesthetic concerns.


If premature aging has caused your facial skin and muscles to droop, you may begin to lose self-confidence. Lost volume, as well as lines and wrinkles, is common with age, but thankfully there’s a non-surgical solution with injectables. The injectables we offer range from soft, medium to firm—depending on the areas you wish to treat.

Soft fillers, like Vobella or Restylane Silk, are able to treat superficial lines around the mouth, lips and forehead. If your concerns are with nasolabial folds or deeper forehead lines, medium fillers may be the better option. Firm fillers, like Voluma and Radiesse, are reserved for those who need extra support and volume to the chin, cheeks, jawline or temples.

With quick sessions that generally only take an hour, many patients come in over their lunch break to receive treatment. Results from injectables typically last anywhere from 6 to 18 months, depending on the type you receive. While the results aren’t permanent, many patients appreciate the subtle transformation—as friends and family usually cannot tell that your rejuvenated appearance is due to a cosmetic procedure.

Laser Skin Resurfacing

Another non-surgical facial rejuvenation option is laser resurfacing. This treatment is most beneficial for those who have sun-damaged skin. Fine lines, wrinkles and sun spots can create an appearance you’re just not proud to wear, but with a laser skin resurfacing treatment by Dr. Sieber you can effectively improve the tone and texture of your face.

The procedure itself is fairly quick and can take anywhere from 15 minutes to an hour to complete. Recovery from laser skin resurfacing will depend on the level of treatment you received. If your skin only required a light treatment, you may only experience slight reddening of the skin for the first 24 hours. Deeper treatments, however, may leave you with red, peeling skin that lasts anywhere from one to seven days.

When to Consider Surgery

If you are seeking more long-term results, we offer many cosmetic surgical procedures which can make a significant and positive difference in your appearance. Whether your concerns are with your eye area, chin, entire face or neck, Sieber Plastic Surgery can effectively turn back the clock on your skin.

Eyelid Surgery

If you’re unhappy with the look of your droopy eyelids or the bags beneath your eyes, an eyelid surgery may be a great option. Also referred to as blepharoplasty, this procedure works by removing the excess skin and fat from your upper or lower lids to provide you with a more refreshed and rested appearance. This procedure may leave you with some mild to moderate swelling and bruising, but this should subside within the first couple of days. While you will likely notice an improvement as soon as the initial swelling goes down, it may take up to six months for your final results.


A facelift by Dr. Sieber can drastically reduce signs of aging by increasing elasticity and tightening loose or tired skin. The procedure itself takes about four to five hours to complete, but the results can last anywhere from five to ten years. As with any surgical operation, you will require some downtime to allow your face to heal. You can expect some pretty severe swelling for the first week after surgery, but as it subsides you will begin to notice your younger, natural-looking appearance.

Neck lift

Sometimes patients are more concerned about the area below the face, such as the jawline and the skin around the neck. This can be treated through a neck lift, which removes the excess wrinkles and fat deposits that can form around the chin. Although the neck is often overlooked, its appearance makes a significant impact on your overall appearance and most patients will be fully recovered after just a couple of weeks.

With so many options, we understand that it might be hard to know how to proceed. That is why we are here to help. Give us a call at 415-915-9000. We would be more than happy to schedule you a consultation and get you on your way to healthy, vibrant-looking skin.

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*Disclaimer: Results may vary from person to person. Editorial content, before and after images, and patient testimonials do not constitute a guarantee of specific results. All images feature models except for before and after images.

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