RealSelf Q&A with Dean L. Johnston, MD

Q: What is Plastic Surgery?

A: Plastic surgery is a surgical sub-specialty that deals with the healing and restoration of patients with injury, disfigurement or scarring resulting from trauma, disease or congenital defects. It includes aesthetic, or cosmetic surgery to correct or rejuvenate facial and bodily features not pleasing to the patient. Derived from Greek, the word plastic means molding or giving form and does not refer to the use of plastic materials.

Q: Is plastic surgery safe?

A: All surgical procedures are accompanied by a certain degree of risk, whether the procedures are for medical or cosmetic reasons. Our expert team is dedicated to making your operation go smoothly. We careful review your medical history and current health condition before deciding if it is safe for you to proceed with surgery. It is important that you fully disclose all pertinent information so that we are able to make an accurate assessment of the risks involved. We will take every precaution necessary to reduce the possibility of any complications.

Q: How do I know if plastic surgery is right for me?

A: There several important factors that come into play when deciding whether plastic surgery is the right option for you. One of the most important factors is your health. Being in good health greatly reduces the risk of complications occurring during surgery and leads to a speedy recovery. Next, you need to ask yourself what your motivations are. People who have plastic surgery generally find that the surgery enhances their overall appearance and self-esteem. Thirdly, you should have realistic expectations. Plastic surgery is both a science and an art, neither of which are perfect. Set reasonable goals as to the result you wish to achieve and be prepared to thoroughly discuss these goals during your initial consultation.

Q: Are you certified by the American Board of Plastic Surgery?

A: Dr. Dean Johnston is certified by the American Board of Plastic Surgery, he also trained at Wake Forest University School of Medicine, he is a Medical Doctor and on staff at Orlando’s premier hospitals and is the chairman of plastic surgery at Orlando Regional Medical Center.

Q: How much does it cost to consult with the doctor?

A: We offer Complimentary Cosmetic Consultations. If you have more questions about your procedure you can contact our nurse practitioner or schedule another consultation with the doctor. We highly recommend having your questions typed, or written, out so you can make the best out of your time with the doctor. Prior to scheduling your consultation we require you to view our online Emmi® tutorial

Q: How much will the surgery cost?

A: Every patient is different. For the best solution to your needs we highly suggest to schedule a consultation with our doctor. At the end of your consultation you will have a much better understanding of what is included with our procedures and what is required for a commitment from our patients.

Q: What is an Emmi® tutorial?

A: 90% of patients said Emmi® gave them a better understanding of how to take care of themselves before and after their procedure. Emmi® is a communication platform that engages our patients and positively impacts their experience throughout the continuum of care. Through Emmi® our patients increase their education about our procedures and become more aware of the pre and post operational procedures.

This online educational tool will help answer many questions our patients or potential patients have. In advance of scheduling a consultation with our doctor one can have a clearer understanding of all that goes into a certain type of procedure.

If you are interested in trying out our Emmi® online educational tool please contact our office and our staff will get you a username and password to login with. After contacting our office it may take up to 24-48 hours to receive your username and password. If you still did not receive your information please contact us directly at 407-333-2525 to obtain your information. Sometimes junk filters collect our emails and they are never completely delivered to our patients.

Q: What happens during my initial consultation?

A: During your consultation we will discuss your desired changes and expectations, review your medical history and current health, and make an assessment on whether the procedure(s) in question are right for you. This is a good time to ask specific questions about the procedure so that you are fully prepared, mentally and emotionally, for surgery. We will discuss the results that can be achieved, with the aid of photos and/or computer imaging. When a final decision is made, you will need to sign an informed consent stating that you are fully aware and understand what is entailed by your pending operation, including the potential complications and secondary effects.

Q: Can I have several procedures performed simultaneously?

A: It is a relatively common practice for a plastic surgeon to perform multiple procedures during one operation. This allows the surgeon to better “sculpt” your final appearance. In addition, having several procedures done simultaneously saves you the expense of paying the operating room and anesthesia costs more than once. However, having too much done at one time can lead to complications. The decision to have multiple procedures done depends on which procedures are being done, the extent of surgery, the operating time, and your age/health. Ultimately, the surgeon decides whether or not it is appropriate to include more than one procedure in your operation.

Q: Does it matter how old I am?

A: Due to the variety of procedures available in plastic surgery, there can be no blanket rule on age although age will be taken into consideration when planning your operation. People of all ages have taken advantage of the image-enhancement offered by plastic surgery. There are even procedures appropriate for young children! It is important to realize the limitations of plastic surgery. Plastic surgery cannot “fix” every situation or reverse the aging process. What is a good procedure for one person may not be an appropriate procedure for another. We are committed to making your plastic surgery experience a successful one.

Q: I just had a baby, how long do I need to wait before having plastic surgery?

A: You should wait at least six (6) months following having a baby before having a procedure. If you are nursing you will need to wait six (6) months after you have finished.

Q: How long will it take to recover from my surgery?

A: Generally, post-operative instructions call for rest and limited movement in order to speed up the healing process and recovery time. The length of recovery varies with each procedure and is different for each individual. Bruises usually disappear within a few days, and most swelling is gone in a matter of weeks. If you follow our post-operative instructions carefully, you will be able to enjoy your normal activities within no time. Your scars will fade over time but are permanent. We take care to conceal any scars so that they are barely visible, if at all. The image-enhancing effects of plastic surgery become more evident over time with certain procedures taking up to a year for your body to fully adjust and settle into its new look. When you come in for your consultation we can discuss your expected recovery period and any post-operative instructions in detail.

Q: Will my insurance cover the surgery?

A: Insurance providers generally cover costs for reconstructive surgery but not for cosmetic surgery. For example, insurance providers will often pay for breast augmentation to reconstruct a breast following a mastectomy; breast reduction to remedy back pain caused by heavy breasts; eyelid surgery to remove sagging skin that blocks vision; or tummy tucks to remedy the vertical separation of abdomen muscles known as diastasis. Insurance providers are required by law to cover breast reconstruction surgery and any cosmetic operations necessary to create symmetry in either breast. If your surgery is covered by insurance, pre-certification is required. We will be happy to assist you with the process.

We offer financing as well please learn more about our financing services by visiting carecredit.com

Q: Do you have hospital privileges to perform this surgery?

A: Yes, Dr. Dean Johnston is the chairman of plastic surgery at Orlando Regional Medical Center.

Q: Are breast implants safe?

A: The issue of breast implant safety has been a hot topic throughout the last few decades. As a result, more stringent standards have emerged in order to protect patients. Current breast implant procedures primarily use silicone shell implants filled with a saline solution. Occasionally, silicone-gel filler is used; but this is highly regulated by the FDA, and generally only acceptable in reconstructive surgery procedures. Rarely, an implant will rupture or leak. With saline implants, the saline is safely absorbed into the body. The effect of silicone-gel leaking into the body is still being researched. If rupture or leaking is detected early, the implant can be easily replaced. Other possible complications from breast implant surgery may include blood clotting or pooling, overly sensitive breasts or loss of sensation in the breasts, and capsular contracture (a hardening of the tissues surrounding the implant). Our expert team is dedicated to making your operation a smooth one. We take every precaution necessary to reduce the possibility of any complications.

Q: What is aesthetic (cosmetic) surgery?

A: Aesthetic surgery, also known as cosmetic surgery, seeks to improve an individuals appearance. These type of operations most often involve the nose, ears, face, forehead, eyelids, breasts, abdomen, hips and thighs.

Q: Is a plastic surgeon a skin specialist?

A: Dermatologists specialize in skin, but the plastic surgeon has an equally important role of the treatment of benign and malignant tumors of the skin. The skills of a plastic surgeon are especially needed when large areas of the skin must be removed and replaced especially where disfigurement may result or when these areas are in conspicuous areas such as the face. Plastic surgeons also perform skin resurfacing techniques, for cosmetic purposes, in order to achieve healthier looking skin by reducing facial wrinkling and pigmentary changes of the skin.

Q: Will I have a scar after plastic surgery?

A: Scarring is inevitable of healing, however a very fine lined scar placed in the correct orientation may be virtually invisible. A plastic surgeon spends years trying to master techniques to place scars in the most desirable location. Plastic surgeons will try to make incisions in areas that will not show, like under undergarments or along natural creases. Scars will normally fade over time, but certain areas of the body such as the back and chest, produce more severe scarring regardless of the technique used for reconstruction and closure. The severity of the scarring varies from person to person.

Q: Does plastic surgery always involve skin grafting?

A: Skin grafting is only used when it is the best way of closing a wound or defect. A qualified plastic surgeon uses judgment to decide the best way of reconstructing a defect. A skin graft may appear to have poor color match and texture compared to the native skin, but with careful selection of a skin graft donor site these problems may be minimized.

Q: What is a pedicle graft or flap?

A: A pedicle graft also called a flap, consists of a segment of skin, underlying subcutaneous tissue and/or muscle which is shifted from one area to an open wound or defect for coverage of that wound. The word pedicle means that the blood supply to the flap is never divided. When the blood supply is completely divided and reattached this is called a free flap, and requires specialized skill in microvascular surgery.

Q: What aesthetic surgical procedures are performed to improve the aging face?

A: There are various degrees and stages of facial aging that can be caused by the natural aging process, heredity, and lifestyle choices. Plastic surgeons have undergone training to address all areas of facial rejuvenation. A face lift tightens and lifts the redundant skin in the face and neck. Additional procedures are available to improve the aesthetics of the forehead, eyes, mouth, chin and neck. Minimally invasive endoscopic techniques are also available. Fine wrinkles of the face may be best treated by skin resurfacing techniques, like laser resurfacing, chemical peels or other skin care treatments.

Q: How can I become a Laser therapy patient?

A: We are currently taking names on a first come first serve basis to introduce our new line of services. If you are interested please contact our office at 407-333-2525. There are many new and exciting procedures that can be done with little to no down time.

Q: How is a face lift done?

A: During a face lift incisions are made in the hair line, temple region extending down in front of the ear and then around the back of the ear into the hairline. These incisions vary depending on the technique used by your plastic surgeon. Many plastic surgeons are well trained in more than one face lift technique. The skin of the face and neck is dissected into the cheeks and neck allowing it to be mobilized upward producing a tightening and smoothing result. Many plastic surgeons can now also tighten the muscular layers underneath the skin as well during a face lift procedure. Years of specialized training are necessary to safely perform this procedure. The results can be subtle or drastic depending on the condition of the facial area prior to the surgery and the desired results.

Q: Does a face lift leave scars?

A: Yes, but as with other scars plastic surgeons have been trained to place them in areas that are very inconspicuous. Your plastic surgeon will be able to show you exactly where your scars will be following your surgery. Normally your hair will cover up most of the scars and makeup can touch up any leftover marks.

Q: How is excessive wrinkling and bagginess of the eyelids corrected?

A: Eyelid surgery can correct this condition. Excessive skin and fat may be removed from both upper and lower eyelid. Tightening of the lower lid may also be done in concurrence with this procedure. One to two weeks of bruising and swelling is expected from this procedure. Eyelid surgery may be done in combination with or separate from face lifts or other types of aesthetic surgeries of the face such as brow lifts to better proportion your facial features.

Q: Is Otoplasty Surgery, or Ear pinning, a complicated process?

A: This procedure is an out-patient surgery, usually done under general anesthesia. We advice to setup a consultation with the doctor to go over the details surrounding your specific needs.

Q: What surgery can improve the appearance of breasts?

A: Three common procedures are performed: breast augmentation, breast lift, breast reduction.

Augmentation mammaplasty is a procedure that can safely enlarge a small breast or increase an undesired size. Different techniques are used, but in general this is performed using a saline breast implant, after the FDA ruled silicone unsafe in 1992. Implants may be placed in different positions depending on the physical make-up of the patient and her breasts. The implant may be introduced through three different incisions: below the breast, around the nipple areolar complex, or in axilla (arm pit).

A breast lift is used when the patient is happy with the size of her breasts however due to aging and pregnancy the breast gland has begun to droop. Various techniques are employed to accomplish a breast lift and results are generally excellent.

Breast reduction is designed to make overly large breasts smaller. Patients seeking this type of surgery often have multiple severe physical symptoms secondary to their large breasts including neck, shoulder, back pain, paresthesia of the arms and bra strap grooving of the shoulders. The technique of breast reduction requires lengthy incisions; however, they may be placed in inconspicuous locations such as the fold underneath the breast. Typical symptoms of back pain, neck pain etc. are almost always improved after a breast reduction if not completely eliminated. This procedure is often covered by insurance.

Q: I am interested in Breast Augmentation…where do I go from here?

A: Breast Augmentation is very popular as the year turns to the seasons of spring and summer. We can help you make this important decision. We prefer to educate all of our patients through Emmi® before consulting with the doctor. This pre-education allows our doctor the ability to concentrate more on tailoring the consultation to the specific needs of our potential patient. After viewing Emmi® please contact us to schedule your consultation. A typical Breast Augmentation consultation generally takes about 45-60 minutes. After your consultation our nurse practitioner will help you with the sizing of your implants. Once you have reached this point you will have a good idea of what to expect with the surgery and outcome.

Q: Am I a good candidate for liposuction?

A: Liposuction is not used for weight loss, rather to correct problem areas or fat bulges. A candidate will be close to their ideal weight because a liposuction is typically performed in patients that have an area of fat they find hard to lose. The fat removed does not weight a lot, so patients should expect a shape change, not a weight change.

Q: Tummy tuck or liposuction? Which is best for you?

A: Tummy tuck is commonly thought of when a flatter tummy is desired. Abdominal fat can be very resistant to diet and exercise. Prior to the development of liposuction, the only real surgical alternative in the diet and exercise – resistant case was the tummy tuck. The tummy tuck procedure is still performed, but liposuction is a better alternative for most patients. The tummy tuck involves the removal of a large amount of skin from the lower abdomen. Therefore, if a very large, or extreme amount of excess skin is present, a tummy tuck is appropriate.

For most patients, liposuction alone is sufficient to correct the problem. The tummy tuck operation is a pretty substantial one. The incision usually extends from one hip to the other, and thus can often be almost 2 feet long. In addition, the umbilicus, or belly button, is often moved downward a considerable amount. In contrast, liposuction surgery involves only a few very tiny incisions which become hardly noticable, and no displacement of the belly button. Recovery after liposuction, particularly tumescent liposuction, is easier than after a tummy tuck as well.

Before making a decision we recommend consulting with the doctor to help determine what is best for you.

Q: Do the results of liposuction last?

A: As long as the patient maintains a healthy life-style, including exercise and a sensible diet, liposuction results are long lasting. Once the fat cells have been removed from an area there is no longer a preferential fat storage area and any fat gain will be distributed more evenly over the rest of the body.

Q: What areas of the body can be treated with liposuction?

A: Most body areas can be treated with liposuction, though the most common areas in females are the abdomen, hips, and thighs. Men are often treated for liposuction in the breasts, hips, and abdomen. Liposuction is not limited to these areas, though other places may include the upper arms, under the chin and the buttocks.

Q: Does liposuction leave scars?

A: Incisions made during liposuction are generally very small and put in areas that are more inconspicuous. Most cases of liposuction will heal well and it will be difficult to see where they were originally made.