I had the pleasure to sit down with Dr. Bryan Forley, Manhattan-based Plastic & Reconstructive Surgeon. Dr. Forley is among the few plastic surgeons who tells his patients what will and will not work for them. He doesn’t see the patient from a financial perspective but really as a model that an artist seeks to perfect. Her passion shows when she talks about her job and being a perfectionist. All of his clients are word of mouth and that’s what he prides himself on. I’m grateful Dr. Forley finds time to share his insights about the latest and greatest treatments available.
SL: The winter elements can be harsh on the face. What do you see as the biggest complaint of some of your patients?
Dr Forley: Winter and the start of the new year are often the defining times when the desire for self-improvement is at its peak. This is the time when people want to tackle the aging changes they see in themselves that have been smoldering through the years or prepare for the inevitable warm weather seasonal shift to outdoor activities when their bodies will be more exposed. A series of problems that are often treated at this time of year give me the opportunity to perform a broad range of surgical and non-surgical procedures.
SL: I know both men and ladies are concerned about sun damage and wrinkles particularly on their faces. What do you recommend for your patients that’s non-invasive?
Dr Forley: The most non-invasive recommendation I have for sun damage and wrinkles is prevention! Premature aging because of extreme sun exposure is a common problem that can be prevented or at least minimized by common sense measures such as regular use of sunscreen not only on the face but also the neck. décolletage, hands and body. Regular use of a moisturizer will help keep the skin hydrated and thus less prone to the development of damaging free radicals caused by exposure to UV rays and environmental pollutants.
SL: We are big fans of Evoke and know that you’re one of the few plastic surgeons using this treatment. Can you share with us how it works?
Dr Forley: Surgery is not for everybody so Evoke provides us with alternative treatments that are totally non-invasive and can have significant results in certain patients. This technology involves sending radiofrequency (RF) energy under the skin to correct the contours of the jawline and neck without downtime or pain. RF energy is delivered from electrodes that are connected for each 45-minute session with special treatment masks for each area and produces a mass heating effect. After a series of 3-6 treatment sessions, the visible improvement looks very natural and complements other non-surgical aesthetic procedures. The duration of the results will vary but maintenance treatment is usually performed at 12-18 months.
SL: Let’s discuss cellulite because I know it is a problem for lots of people. What treatment do you offer for this patient?
Dr Forley: Cellulite is a common problem that’s seen largely in women after a certain age. This is related to the distribution of fat, the fibrous bands that cross the fat to the surface of the skin, and hormones. Various treatments are available from creams to energy devices to injections which all have varying results. Often when there are multiple solutions, it is a sign that none of them are working properly. We recently started using the Body Morpheus8 device to tighten skin, remodel fat, and disrupt fibrous bands in an effort to accomplish a multi-pronged approach to cellulite. This technology delivers radiofrequency energy using an applicator with multiple microneedles that can be adjusted to penetrate to different depths beneath the skin’s surface. A series of 4-6 monthly sessions is normally recommended initially when a patient is assessed to be a candidate for this innovative cellulite treatment. Maintenance treatment at 12-24 months will be required in most cases.
SL: Breast implants. Are you for or against them? Are there any long term side effects? Can cancer still be detected in the same way as in natural women?
Dr Forley: Silicone gel or saline filled breast implants provide customized solutions for a number of breast problems including size, sagging, asymmetry and developmental, and reconstructive problems.
Although dissatisfaction with breast size is the main motivation in deciding to endure breast implant surgery, improving self-esteem can be equally important for both younger and older patients.
Post-pregnancy changes in the breasts can often lead to a deflated and sagging appearance. This contributes to body image issues combined with changes in the appearance of the abdomen after delivery. These two problem areas are often addressed with what is usually called a “mommy makeover” where a tummy tuck is combined with implants to replace lost breast volume. In some cases a breast lift may additionally be indicated but higher profile implants can often add enough projection to lift the breast without additional scarring.
Breast asymmetry can be the origin of many psychological problems that can be detrimental to the growth and development of affected patients. Compensating for the difference in size by using implants of various volume and dimensions in each breast can result in a really successful resolution of the problem. In some cases, greater breast reduction and smaller breast size enhancement with implants may be indicated.
Reconstruction after breast cancer treatment can restore the appearance of the breast with a combination of tissue augmentation and implants. The process often begins with cancer treatment and is known as immediate reconstruction.
Specific long-term risks for implants are implant collapse, capsular contracture or breast lumps, and rippled or uneven surfaces. These and other rare risks will be discussed during the initial consultation with your plastic surgeon. Diagnostic tools generally used for screening and detection of breast cancer are found to be effective in the presence of breast implants.
SL: Is there a certain age when someone should start with non-invasive treatment that means is it safer at a later age compared to someone in their 20s?
Dr Forley: There are a number of non-invasive or minimally invasive treatments that offer beneficial results for the aesthetic appearance of the face and body irrespective of the age of the patient. I believe realistic expectations for improvement according to the type of treatment used is the key to patient satisfaction. Safety is more a function of matching the correct procedure to the patient’s needs than relating the procedure to their chronological age.
SL: Please share with us the other treatments you are using and recommending to your patients and distinguish who is a good candidate for each.
Dr Forley: An area that is usually of concern to both men and ladies is the effect the appearance of their lower eyelids has on how they see themselves and how they’re perceived by others. Raised fat pads on the lower eyelids, wrinkled or less elastic skin, and visible under-eye circles known as tear troughs contribute to the aged and tired look related to drooping lower eyelids. Fortunately, we have a wonderful option for dealing with this problem. When tear troughs are related to mild protrusion of the fat pads, injectable fillers can be used to blend the transition from eyelid to cheek to create a more uniform surface contour that successfully corrects these signs of premature aging in a minimally invasive manner.
In more advanced stages of drooping lower eyelids, transposition of the lower eyelid fat removal or blepharoplasty is performed. This surgical procedure is performed through an incision on the inside of the lower eyelid so that there isn’t any visible scar. This involves first releasing the tight bands responsible for creating the tear trough depressions. The fat pad present on the lower eyelid is then removed or diverted to fill in the eyelid junction once the surplus fat is removed.
This results in the appearance of brighter and younger eyes that look natural and non-surgical. Skin elasticity or wrinkle problems are often treated with laser or radiofrequency treatments.
SL: As all the time, it was a pleasure talking to you and we look forward to doing more interviews in the spring.
DR: Forley: It’s my pleasure and that I hope to talk to you again soon.
Bryan G. Forley, MD, FACS
5 East 82t Road
New York, New York 10028
Plastic & Reconstructive Surgery