FAQ

• How does a patient choose implant size for breast augmentation?
• Are silicone breast implants safe?
• What can a person expect after a Botox treatment?
• Is it true you can elect to a have a c-section and lipo/plastic surgery at the same time?
• How does a person decide which filler is best the best choice?
• How quickly can a patient return to the gym after a tummy tuck or liposuction?
• What can a patient expect after an IPL photofacial?
• What is the best “order” for doing body contouring after weight loss surgery?

How does a patient choose implant size for breast augmentation?

The specific breast implant size, type of implant (silicone versus saline) and the position of the implant are determined in consultation with Dr Monaco.  The size of an implant requires considering different factors.  A patient’s breast width, tissue quality and body shape are some of the factors that are considered when choosing the right implant size for a patient’s body.  Many patients state that they wish to increase from a 34B to a “full” 34C or a 32AA to a 34B and these are bra sizes that vary between different brands of bra manufacturers.  It’s difficult to meet these expectations and subsequently, Dr Monaco has many different implant sizes available to try on during a consultation.  Patients are encouraged to bring a tight fitting sports bra and tight fitting t-shirt to try to simulate what an implant may look like in tight clothing after surgery.  This is only a rough guideline and subsequently taking time to discuss a patient’s goals for breast augmentation is very important to Dr Monaco when choosing a range in implant sizes.

Are silicone breast implants safe?

Many years of research and development and scrutiny by the FDA has resulted in a modern cohesive silicone gel implant with a non-bleeding shell that is a safe and FDA approved.  Older silicone gel implants had problems with silicone bleed and gel migration after rupturing that has been corrected with the current generation of breast implant.  Choosing an implant that is FDA approved is crucial as the same safety guidelines may not have been imposed on implant manufacturers from other countries.  The recent problems with the PIP implants in Europe have created devastating issues for patients who have had breast augmentation in various countries in Europe.  In the United States, Mentor (made by Johnson & Johnson) and Natrelle (made by Allergan) are excellent implants with well researched literature that illustrates safety in long term studies.  Starting in 2012, patients will have another option for silicone breast implants from a third company, Silimed.  Patients can choose an implant from Sientra (Silimed) or Mentor or Natrelle.  The FDA has approved this implant which means that it is a safe product equal to the standard for Mentor and Natrelle.

What can a person expect after a Botox treatment?

For most patients, the effect of Botox takes between 4 and 7 days.  Bruising may occur but this is typically rare.  Each Botox treatment that Dr Monaco administers is tailored to a patient’s specific needs and concerns whether this involves making crows feet more subtle or treating the dreaded number “11”s in between the eyebrows.  Botox is used for diminishing the appearance of wrinkles without going overboard and making a patient look frozen.  The amount of time that Botox will last varies from patient to patient.  Some patients need Botox every three months and others only opt for it once a year.  Typically, the results last between three and six months.

I am so glad to have found Doctor Monaco. She is a caring and knowledgeable doctor that listens to her patient’s needs. She listened, advised, explained my options and I could not be happier. I had vertical lines between my brows and always looked angry…no matter how happy I was. Now I look happy and relaxed. She treated me with botox and I love it! He staff is friendly and very helpful. The office is immaculate…..another big plus! Will never go elsewhere.

J.R.
Jamaica, NY

Is it true you can elect to a have a c-section and lipo/plastic surgery at the same time?

In an age of instant gratitude, women and new moms are often feeling the crunch to fit back into their pre-pregnancy clothes within weeks of delivering their babies. Reality TV and popular magazines are constantly showing pictures of celebrities who are in their bikinis within days of delivering their infants and let’s face it… they always look fantastic. It’s the celebrity mom who goes into hiding to take the weight off at the gym with proper food choices and lifestyle choices that never really gets the press of the instant bikini moms. So, are these celebrities having a little plastic surgery on the side when delivering their babies? It’s possible and no one but the patient can really confirm this but is it optimal? The simple answer is “yes” it’s possible to have a tummy tuck or liposuction done at the time of a c-section but “NO!” it’s not optimal.

Many women come to my office in their third trimester of pregnancy seeking a tummy tuck at the time of their c-section and I always tell these patients to wait. The focus on a c-section is to safely deliver an infant while keeping the mother safe in the peri-operative period. Performing an elective procedure at the time of a medically necessary one is an option that comes with greater risks for blood clots and infection than is worth undertaking. In an age of instant gratification, I still tell these women to wait and I do not perform their requested procedures at the time of their delivery! Sometimes I lose a patient to the plastic surgeon who is willing to take this risk…but my goal is safety first before anything else.

Women who take the extra pounds of pregnancy off with diet, exercise and conventional means then seek consultation for liposuction or a tummy tuck will have a much better cosmetic result than women who have a combined procedure at the time of a c-section. The uterus needs several weeks to contract back down to a non-pregnancy state as do the skin and muscles of the abdomen. The stretch and strain on the abdomen and the water retention from pregnancy make performing a tummy tuck at the same very difficult to estimate how much extra skin can come off versus how much will contract back on its own. If there’s an ugly scar on the abdomen from a previous C-section, that scar can safely be removed at the time of a second (or third) C-section but that’s a far cry from considering a tummy tuck during this setting. It’s also difficult to tighten the muscles of the abdomen when the uterus is still enlarged from the pregnancy, as it’s much easier to get them tighter when there isn’t a physical roadblock like the uterus to get around.

The bottom line from this plastic surgeon is for a mom to wait until her body has recovered from the strain of pregnancy. The best results come when a mom feels that she has reached as close to her pre-pregnancy shape or weight and is ready to take care of herself with whatever “mom-job” she chooses for her to look and feel fantastic. When needed, it’s a procedure that is truly deserved after the miracle of childbirth…and one that is worth the wait.

How does a person decide which filler is best the best choice?

Many patients come to Dr Monaco’s office with a specific product in mind because they have heard about it from a friend or researched it on the internet.  And, many doctors have specific areas that they prefer for Juvederm® or Restylane® versus Radiesse® and Scupltra Aesthetic®. Dr Monaco will tailor a treatment session with filler to a patient’s specific goals.  She will use a particular product if requested by a patient if it is an appropriate choice.  The majority of patients, however, defer to Dr Monaco’s expertise for filler choice and areas to be treated.  There are areas of the face that typically do better with Juvederm® or Restylane® and other areas that are best treated with Radiesse® or Sculptra Aesthetic®. 

Dr. Monaco is amazing! I am so sensitive and get very nervous around needles and she makes it as painless and quick as possible! Dr Monaco also makes sure that I am more than happy with the results! She has even called me after my first filler treatment to see how I was doing!! What doctor does that!!? Great doctor all around. Wish she had an office downtown!!!Molly K.
Manhattan, NY

How quickly can a patient return to the gym after a tummy tuck or liposuction?

The recovery from a tummy tuck versus liposuction of the abdomen and flanks is very different.  Patients who have tummy tucks cannot lift anything greater than 10 pounds for a few weeks and will wear an abdominal binder to help support their healing incisions.  All surgical patients are encouraged to ambulate immediately after surgery but returning to the gym is limited until two weeks after liposuction and four weeks after a tummy tuck and these are only guidelines and are tailored to each patient’s recovery.  Liposuction patients often times need to wear a support garment that helps to give support to the area that has been liposuctioned.  The area can have some bruising that usually resolves in a matter of days.  Results are seen immediately with both procedures but it typically takes several weeks to get to the final appearance after a tummy tuck or liposuction.

What can a patient expect after an IPL photofacial?

A photofacial typically takes about 30 minutes including time to discuss the risks and benefits of the procedure with Dr Monaco.  Patients may experience a small amount of redness after a photofacial and sometimes the skin can feel a little dry for a couple of days afterwards which can be treated with any moisturizer.  Typically, there is no peeling or discoloration that anyone would notice after a photofacial so, essentially, there is no downtime.  In the days and weeks that follow a photofacial, patients notice that their skin has a more even appearance and a healthy glow.  Areas of brown sun damage are typically a little lighter and patients will sometimes find they have lost their daily dullness after IPL.  Dr Monaco will tailor a photofacial to a patient’s skin type and amount of sun damage.  Many patients will require more than one treatment session and it is common to anticipate a few treatment sessions to get the best possible result. 

She I typically see Dr. Monaco for Botox, Juvederm and photo-facial treatments. Dr. Monaco is a very knowledgeable, caring and kind surgeon who is as talented as she is artistic. She attentively listens to my concerns and answers all of my questions before performing any procedure. Dr. Monaco makes you feel very comfortable throughout the entire process. She cares about each patient as a person. She feels like a friend. She ALWAYS calls me personally within a few days following any procedure, no matter how small the procedure is, to see how I am doing. She’s also the only doctor that has given me her cell phone number that I’m at liberty to call at anytime in the event I have complications….which I’ve never had. I highly recommend Dr. Monaco.Jen B.
Manhattan, NY

What is the best “order” for doing body contouring after weight loss surgery?

Patients who have had weight loss surgery have unique areas that they choose to focus on first…some patients want a tummy tuck or body lift before considering any procedure on their breasts while others prefer to have their arms and thighs treated before anything else.  What’s most important is waiting until weight loss has stabilized for at least six months and that a patient is happy with the amount of weight that is lost.  Many times a lap band needs to be adjusted for more or less weight loss before considering plastic surgery.  Another factor that is crucial to Dr Monaco is a nutritional assessment as many patients have vitamin and mineral depletions that are caused by their weight loss procedure so all patients will require evaluation by an internist to assure that various nutritional parameters are within normal limits before proceeding with surgery.  The “order” that a weight loss patient undergoes body contouring is decided between the patient and Dr Monaco to customize a surgical plan with a patient’s individual goals.  There is no “right” or “wrong” order for body contouring.  Dr Monaco will guide a patient to create a surgical plan that will give the best possible results while proceeding in a manner that is safe and effective.

After I lost over 125 pounds I turned to Dr JoAn Monaco to help me with the next part of my transformation. In a staged procedure I had a breast lift, thigh lift and abdominoplasty. To say that I am thrilled with the results would be an understatement. Dr Monaco is a true artist as well as a compassionate and caring surgeon. Her preoperative consultation was thorough and honest. She discussed exactly what she would be able to do for me and what I could expect after surgery. Dr Monaco and her entire office staff were wonderful. She was available to me and my husband, both before and after surgery, to answer any questions. I would not hesitate to recommend Dr JoAn Monaco. For me, she was the perfect surgeon to guide me through my body contouring journey.Linda R.
Manhattan, NY