No matter what the procedure, careful consideration, research and evaluation is necessary before committing to elective surgery. There are many questions to be asked and options to consider.

We caught up with Tempe, Arizona Plastic Surgeon Dr. Richard Pavese to discuss his insights into the patients’ decision making process. Dr. Pavese is a board-certified plastic surgeon, certified by the American Board of Plastic Surgery and a member of the American Society of Aesthetic Plastic Surgery. He has over 25 years of experience in the Valley. We learned tips for choosing a qualified surgeon and about an up-and coming Fat-Grafting procedure that is used both in reconstructive as well as cosmetic surgery.

Q: When choosing a Surgeon, why is it important for people to be aware of their surgeon’s board certification?

A: Board Certification means that a surgeon has had formal training in Plastic Surgery. To be certified by the American Board of Plastic Surgery the surgeon must have at least five years of surgical training after medical school of which two years are in Plastic Surgery. They then must pass a certification exam in Plastic Surgery. The training is in-depth so that a surgeon can handle cases that are more difficult as well as complications if they arise.

Q: There are many doctors with all types of backgrounds performing Facelifts and Breast Augmentation. How can just anyone perform Plastic Surgery?

A: The Medical Board does not license for specific procedures, they license for the practice of medicine. If the surgery is done in a private office there is no oversight. To do surgery in a hospital you must be specifically trained and certified in that area of medicine. So hospital privileges are also an indication of specific training.

Q: What would you say is the main emphasis in your practice?

A: We primarily do cosmetic procedures; especially breast surgery. Breast Augmentation, Breast Lift, replacement of prior implants with new silicone gel implants, and Breast Reconstruction.

Q: How long is the recovery following Breast Augmentation?

A: We seek to get patients back to work within a few days. Many of our patients choose to have Augmentation under a local anesthesia with a gentle sedation so that they don’t have to recover also from a gas anesthetic. More strenuous activities such as working out may be possible in 2-3 weeks. Recovery rates also vary between patients.

Q: Is there anything to alleviate patient’s apprehension before Breast Augmentation surgery?

A: Before the consultation we try to give patients as much information as possible. This increases their comfort level. Our website shapely.com is helpful in this regard. It demonstrates and discusses silicone versus saline implant choices and other background information.

Another source of anxiety is what they will look like after surgery. In this regard we have a 3-D imaging system to show what a specific sized implant will look like on their frame. We will also show photographs of people with similar frames and sized with a specific implant. Implants are also tried on inside of their clothing so they can get an idea of what to expect after surgery. Between the imaging system, before and after pictures, and trying on the implants, patients leave their consult with a good idea as to what they can expect after their surgery.

Q: What can a patient expect during a Breast Augmentation consult?

A: We first obtain a complete medical history and physical examination as well as an analysis of the patients frame. All decisions are discussed including choice of implant types, silicone versus saline, incision location, size, shape, need for a lift etc. We listen to the patient’s goals for the procedure. The procedure can be done under either a general or a local anesthetic which is also discussed with the patient.

Q: How long is the recovery, typically?

A: The recovery varies by activities. If they want to drive, they can as soon as they are off pain medication. If they want to water ski they will likely need to wait five to six weeks. It is dependent on what the patient wants to do. They might not be at the gym doing a workout for two to three weeks. It’s like any surgery- knee surgery or ankle surgery- there is a healing process involved.

Q: What would you say is the average downtime for everyday life?

A: Between three to five days depending on the type of job they want to return to. An office job might be three to four days. Many patients who have surgery on a Friday can be back to work on the following Monday or Tuesday.

Q: Are there any other procedures that are on the rise or up-and coming?

A: Fat-Grafting. Fat-Grafting is something that is [becoming] popular mostly for reconstructive surgery, for example patients who have had radiation for breast cancer. It can be done to help with ripples from radiation and a mastectomy; or even ripples from an old saline implant [a patient] doesn’t want changed out. It’s also very good in facial surgery. After 40, your face loses fat; several cc’s of fat a year. Fat grafting in the temples, cheeks, brows, lips and nasal labial fold, is an up-and-coming procedure that is not given enough attention. Fat is what you lose in middle age- and we’re going in and replacing it. It is something that’s new and very, very useful.

Q: How is that type of procedure done?

A: If you needed a small amount of fat- say for filling in a temple hollow, that procedure is done in the office, with a syringe, as an outpatient. Somebody who had a facelift years ago and wants fullness- we might need surgery to harvest the fat from a larger area. The question of whether you need to go to the operating room depends on the amount of fat you need to take- that impacts the size of the operation we’re doing. [Fat-Grafting] has a very wide range of uses. Facelift surgery is often combined with fat-grafting to restore the fullness lost in the temple, cheek, nasal labial fold and lip region. The fat is thought to have stem cells- we’ve had wonderful luck fixing irregularities on people’s noses, we’ve had luck fixing radiation damage to the armpit from breast cancer. It’s exciting.

Q: How do people visualize how they’ll look with Fat-Grafting?

A: You can show them what they’d look like with fuller cheeks- I can inject saline into the spot to show exactly what it would look like- then we can duplicate [with Fat Grafting].

Q: How long does Fat-Grafting last?

A: About half of the fat lasts forever. And has the feeling and fullness of your own tissue. It’s unparalleled for someone who’s lost fat from an accident or trauma.

Q: What else do our readers need to know about you, Dr. Pavese?

A: We try to give people good value. If they’re going into surgery, they have a financial expenditure. We want to give them value for the expenditure and value for the healing process they’ll go through. Also, honesty- if something won’t help you, we won’t sign you up.