October, 2011 | Dr. Forley
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Archive for October, 2011


Wednesday, October 26th, 2011

There are several procedures, both surgical and nonsurgical, that can improve a sagging neck. The most common cause of the sagging appearance is loose skin, which is often hereditary and can be more pronounced after a rapid weight loss. Gravity also takes its toll on the formerly taut neck of youth. A history of sun exposure contributes to laxity due to its negative effect on skin elasticity. Excess fat deposits will alter the contour of the neck by producing a bulge. The edges of the platysma, a thin muscle that lines the neck, develop the appearance of thickened cords below the chin and become more prominent with age. We will discuss three options used by Dr. Forley to treat the sagging neck.


Ultherapy® is a new type of non-surgical treatment that uses ultrasound energy to selectively heat the deep layers of the neck that have lost their elasticity and firmness over time. Because the sound waves pass directly below the surface of the skin, the deep support layer responsible for sagging is tightened without affecting the outer skin layer.

Before and 1 Month After Ultherapy of Face & Neck

Before and 1 Month After Ultherapy of Face & Neck 

Following an Ultherapy® treatment, the building of new collagen occurs gradually over the following two to three months. Significant lifting results can be seen due to the combination of contraction of the tissues and new collagen formation. Ultherapy® is often recommended in the early stages of neck aging when surgery is not yet indicated.


Liposuction can be used to remove excess localized fat deposits in the neck and to define the jawline.

Before Liposuction of Neck


After Liposuction of Neck

After Liposuction of Neck

The desired amount of unwanted fat is removed through a small incision under the chin using a cannula, a specialized tube for liposuction. Skin contraction is stimulated by the procedure so that mild laxity will usually not require any additional tightening procedures. Potential bruising and swelling can be limited by use of a compression band for 2-3 days. Many patients return to work within a few days.

Neck Lift

A neck lift restores the contour and appearance of a youthful neck by removing excess fat and tightening the loose skin and muscle that causes a loss of definition.

Before Neck Lift


After Neck Lift

After Neck Lift

To reposition your neck tissues, skin and deeper layers of the face are first very carefully mobilized using incisions located behind the ear. Excess fat may be sculpted using liposuction to further improve the result. The neck bands are treated by use of a specialized row of stitches under the skin to provide better muscle support and optimal contour of the neck.  Excess skin is removed and the incisions are carefully closed to produce fine, minimally apparent scars.

In some cases, more than one factor is responsible for a sagging neck, and a combination of procedures may be necessary. Dr. Forley will discuss the best options for your individual needs during your consultation.


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Tuesday, October 18th, 2011

Anesthesia involves the use of medicines to block pain sensation during surgery, alter your level of consciousness, and reduce many of your body’s normal stress reactions to the procedure being performed.

The type of anesthesia used for your surgery depends on the extent of the surgery, your medical and allergy history, physical exam, and blood tests. There are four types of anesthesia that Dr. Forley uses for cosmetic procedures: local, IV sedation/twilight, general, and epidural.


Local Anesthesia

Minor surgical procedures can be successfully performed using local anesthesia alone. Dr. Forley administers local anesthetics directly into the surgical area with a small needle, resulting in an immediate numbing effect that lasts up to 60 minutes. At times, small doses of epinephrine are added to constrict the blood vessels, produce less bleeding, and allow the anesthesia to last twice as long.

During liposuction, a technique called tumescent anesthesia is commonly used. A large volume of fluid containing lidocaine and epinephrine is injected into the surgical area. The area remains numb throughout the procedure and frequently for several hours afterwards. This technique is usually combined with intravenous sedation/twilight anesthesia to maximize your comfort during surgery.

Intravenous Sedation

Intravenous (IV) sedation also known as “twilight anesthesia” is a safe and effective method for more extensive surgical procedures that require you to be more relaxed or asleep and is performed by a board certified anesthesiologist in Dr. Forley’s Joint Commission accredited office based surgery facility. Precise amounts of sedating and anesthetic medication are delivered while your comfort level and vital signs are carefully monitored. IV sedation is typically combined with injections of local anesthetic at the surgical site for additional pain control and to minimize bleeding.

IV sedation is a good middle ground between local anesthesia and general anesthesia and is often preferred over general anesthesia because patients recover more quickly with fewer side effects. Furthermore, the anesthesia can be lightened, if desired, to a level called conscious sedation during which you remain awake but your awareness of what is happening to you is decreased. Once the medication is turned off, you will wake up rapidly.

General Anesthesia

General anesthesia is a method of enabling deeper anesthesia that is typically used for more complex or longer surgical procedures. This type of anesthesia is done at the hospital by an anesthesiologist and is administered intravenously or by inhaling medication to provide pain relief, muscle relaxation, and amnesia. During the procedure, you will be carefully monitored by the anesthesiologist.

The advantage to general anesthesia is that it allows you to remain motionless for long periods of time. The disadvantage is the increased risk of side effects, complications, and a longer recovery period. Although the medication dosage is always adjusted for variations in weight and health status, the risk for complications increases when medical problems such as heart or lung disease, obesity, malnutrition, or liver damage are present.


An epidural uses a catheter to inject local anesthetic into the epidural space surrounding the spinal cord. The catheter is sited in the lumbar area of the spine and enables procedures to be performed safely once the numbing effect on the nerves, which transmit pain signals from the abdomen and lower body, is in place. Dr. Forley will usually combine an epidural with twilight sedation anesthesia to maximize your comfort during tummy tuck and thigh lift procedures.

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Sunday, October 9th, 2011

THE JOINT COMMISSION National Qualety ApprovalDr. Forley provides the convenience and privacy of an office based surgery facility for his cosmetic surgery patients. His facility is fully accredited by The Joint Commission, an independent, not-for-profit organization, founded in 1951, that strives to improve healthcare outcomes by developing the highest standards for quality and safety in the delivery of health care. Accreditation means that Dr. Forley’s office based surgery facility regularly undergoes a challenging and comprehensive evaluation by an independent reviewer who visits the facility.

By setting expectations that are reasonable, achievable and surveyable, The Joint Commission provides the foundation of a process that helps health care organizations measure, assess and improve performance. Input from multiple sources is used in the ongoing development of new standards related to patient safety or quality of care that will have a positive impact on health outcomes. The on-site survey process focuses on evaluating actual care processes by tracing patients through the care, treatment and services they received. The review monitors how well the following key components are met prior to the awarding of Joint Commission accreditation:

  • a safe environment is provided for your care
  • you are educated about the risks and options for your diagnosis and treatment
  • your rights as a patient, including your privacy rights, are protected
  • your condition, before, during, and after diagnosis and treatment is properly evaluated
  • appropriate procedures are in place to protect you against infection
  • preparation for emergency situations are of the highest standard

Although the majority of Dr. Forley’s cosmetic surgery procedures are performed in his office surgery facility, he also has hospital privileges at Beth Israel Medical Center, New York Eye & Ear Infirmary, and St. Luke’s – Roosevelt Hospital Center. Both office and hospital options are available to all patients, and will be discussed during your consultation.

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Saturday, October 1st, 2011

The General and Plastic Surgery Devices Panel of the Medical Devices Advisory Committee to the Food and Drug Administration (FDA) met in August 2011 to discuss and make recommendations on issues related to silicone-gel filled breast implants. Dr. William Maisel, chief scientist for the Food and Drug Administration’s Center for Devices, re-confirmed the FDA judgment that silicone-gel implants are safe and effective for their intended use in breast augmentation.


The FDA placed restrictions on the use of silicone-gel implants in 1992 due to concerns about a possible link to autoimmune disease such as rheumatoid arthritis and lupus. Clinical trials conducted over the next decade failed to show any evidence of an increased incidence of these conditions in women with breast implants. In November 2006, supported by scientific evidence, the FDA removed the 1992 restrictions on the use of silicone-gel implants made by Mentor and Allergan. As an additional safety measure, the FDA required companies to conduct decade-long studies of their implants’ performance. The FDA has also looked at the studies conducted to gain approval, which have longer and better follow-up than those launched after the 2006 decision. Other studies published in the scientific literature and reports of adverse events helped complete the picture, Maisel said.

When considering both current and future post approval study designs for silicone-gel implants, the panel discussed methodologies and strategies that could increase compliance with follow-up. As discussed in a number of questions about methods and data collection, the panel felt that a breast implant registry of all women who receive the device may provide a means to answering many of the longer term and real world questions, in particular the questions associated with rare adverse events.

The FDA and the Devices Panel consider MRI as the gold standard for evaluating breast implants for evaluation of rupture. However, a 2006 requirement for regular MRI follow up studies following breast augmentation was deemed by the panel to be expensive and unnecessary. Dr. Forley advises his patients to return for annual follow up exams. They are also encouraged to see Dr. Forley in the interim if there is any change in the appearance or feel of the breasts after surgery.

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