Penis enlargement, or augmentation phalloplasty, is a continual topic of controversy false claims and dangerous interventions.  While an array of magical creams, pills, drinks, devices and exercises are sold to anyone willing to pay, none of these interventions can truly yield a change in true penis size.  Many of these unregulated interventions can be dangerous and some can even interfere with normal penile function permanently.  In the past years many different surgical techniques have appeared capitalizing on this specific demand.  While there are many surgical interventions offered, it is very important to consider the risks against the benefits.  One must always remember that a small functioning penis is much better than a large impotent one!  Structural lengthening of the penis is possible by transecting a portion of the ligament that retains the penis attached to the pelvis and this is certainly considered an acceptable surgical option.  Dr. Maercks does not perform this procedure because of the vascular disruptions necessary to complete this transection.  The penis becomes erect through the actions of small muscles in small blood vessels, the arterial side opens more and the venous side closes more.  These actions cause retention of blood in the penis.  Because the delicate balance can be easily offset by an aggressive surgical intervention, impotence is a risk of ligament transection and thus in Dr. Maercks’ opinion should be avoided.  Many have suggested structural implants and organic implants such as AlloDerm.  These also should be avoided in Dr. Maercks opinion.  Artificial implants can extrude, cause infection and further damage to the delicate balance of penile physiology.  Organic implants can also cause similar disruption and placement of either type changes penile sensation which can cause impotence or decreased pleasure with sexual contact.

For the above reasons Dr. Maercks has developed his own technique of structurally enhancing and augmenting the penis without incisions or foreign bodies.  Dr. Maercks has developed a technique to reliably increase length up to 100% in a small penis and increase girth by 20-40%.  The technique involves harvesting adipocytes, or fat cells, from the patient’s own body.  The fat cells are harvested and treated in a manner that allows injection of a combination of adipocytes, stem cells and growth factors.  By placing these grafts into specifically designed areas in and around the penis, Dr. Maercks is able to create a much larger and aesthetically balanced penis without disrupting sensation or vascularity.  The results are permanent and patients usually report dramatically enhanced self-confidence and enjoyment of sexual activity.  Using Dr. Maercks’ HistiocentricTM approach, the penis is not only larger but more effective and balanced with a contoured glans that enhances sensation for both partners and a fuller girth.  Unlike other approaches, this HistiocentricTM approach actually increases penile vascularity thanks to the stem cells and growth factors and thus improves penile health.  Call (305) 328-8256 for a free consultation to see if Penile augmentation with Dr. Maercks’ fat grafting technique is right for you.

In the modeling industry we are continually confronted with a thin line between too much and too little, skinny chic/malnourished, healthy normal/overweight, hair too long/hair too short, color too plain/too rich and of course breast too small/breast too large. For models with smaller breasts, there can be limitations on their bookings while for select bookings this feature can be advantageous. Many models wish to open the doors to the larger array of bookings by having a subtle, natural appearing breast enlargement, but have well warranted fears of ruining their career. We have seen many models commit this fatal mistake by wishing to be too large or simply having an unnatural ‘augmented’ appearing result that was simply not expected.

To explore the truth and fiction of this dilemma we interviewed Dr. Rian A. Maercks as he consulted a Florida runway model, Dr Maercks is a Miami plastic surgeon that has become the favored practice for models and actors seeking subtle facial and breast changes that absolutely cannot appear surgical. We asked Dr. Maercks what the most common surgical procedures were that professional models and actors sought out.

RM – “Believe it or not the most common request from models, actors and their agents are facial changes.”

He explained that commonly there is something that is just a little off that separates would be superstars from crossing that good to great bridge. Agents, directors and models alike notice something wrong like lip proportion or tired eyes. The most interesting thing about this finding is that Dr. Maercks usually identifies a subtlety other than the issue identified. When the complaint is the eye, it usually is a problem with check projection, height or brow
fullness.

RM- ” My job is fun because I have the opportunity to analyze each case and perfect the aesthetic balance of an already beautiful face! Every face has a longer side and a shorter side, sometimes it’s just a matter of balancing this by adjusting the cheek, chin or jaw line.”

All this sounded quite invasive until Dr. Maercks explained that 90% of the models that he performs these adjustments on receive a non-invasive treatment with a filler such as Juvederm.

Dr. Maercks enthusiasm for facial contouring was difficult to curb, but we quickly redirected to the question at hand: Should models have breast augmentation? Dr. Maercks paused with a frustrated yet humored look on his face and replied…

RM- “You do realize it is not that simple right? plastic surgery is a very individual matter and there are very few hard and fast rules. These decisions take careful thought and consideration for your average person, and are even more complex for models, actors and celebrities!”

At that point I figured ‘can models safely have a breast augmentation and actually enhance their career?’ would be a more appropriate question. Dr. Maercks quickly replied…

RM- “of course they can! They just need to know what they are doing. Models need to be even more educated because the augmentation that they are after is very very different from the average person. Models generally will need a smaller size increase and much, much less projection than most people can take on. The trick is that it is not just as simple as choosing less volume or a smaller implant. It is so important that the implant is tailored to the patient’s chest,wall dimensions and features. This is why most of my augmentations on all of my patients use low profile implants while the norm in plastic surgery is to use high profile to ultra-high profile implants!”

That statement of course warrants a reply of ‘well why do most plastic surgeons do the opposite?’ Dr. Maercks again paused and slowly replied…

RM- “ Well you have to think of the image conjured by breast augmentation and what people visualize as a successful augmentation. There has been a tendency to focus on projection, or how far the implant sticks out, and a loss
of focus on breast form. The telltale signs of a breast augmentation are a wide plateau at the sternum, a separation of the breasts at mid line, as well as an unnatural lateral contour and perhaps the worst of all, muscular animation or jumping of the breasts with arm movement!”

Well all of that sounds pretty incompatible with a super model’s career so I obviously asked ‘why should any model even consider this stuff??? Smiling, Dr. Maercks coolly replied

RM- “ It doesn’t have to be that way” (as if I just walked into his trap!) He continued…

RM- “If my first model breast augmentation had any of those features it would have been my last, the modeling community is brutal and does not tolerate slip ups!”

Naturally I asked ‘so what are your secrets?’

RM- “Well if I gave all of them to you they wouldn’t be secrets, but I will give you a few”

RM- “ The first one is quite simple, I already gave it to you, go to a doctor that is actually looking at you and envisioning what breast changes will make your whole body and persona reflect your true image. This includes
ensuring that the implant is wide enough to avoid the quick appearance of a ‘rock in a sock type breast.’”

I could not hold back but broke out into laughter not only because I didn’t expect this type of phrase to come out of the composed, professional and impeccably dressed Dr. Maercks, but because I knew exactly what he was talking about. I have personally seen several ‘rock in a sock’ type breasts and after hearing that I just cant think of a better way to describe them! ‘So the width of the implant is more important than its thickness’ I asked after regaining composure.

RM- “Absolutely!” in my hands the projection is the least important part. I typically use low profile implants which have very little form intrinsically. . .it is the technique I use that creates projection and it does so in a more tear
drop type shape.”

I couldn’t help but interject ‘ tear drop implants are not available in the United States!’

RM- “Exactly! that is one of the reasons relatively formless low profile implants are so important for my work on models! I use a unique technique that was developed by Dr. Ruth Graf, a world renowned plastic surgeon. It is called subfascial augmentation. I modified the technique into what I call ‘cold subfascial augmentation.’ The technique leaves the pectoralis major muscle alone so the irregular movements and shapes associated with sub muscular augmentation are avoided but perhaps even more importantly, it provides support of the implant like a natural shaping bra inside the breast!”

‘Alright a bra inside the breast?’ I was all ears.

RM- “…the fascia is the strong layer that coats the muscle and allows it to communicate force. We lift this fascia and actually use it to turn a round implant into a tear drop implant with a narrowing to the top like a natural beautiful breast. Since the breast is never entered, the fascia also drapes the natural breast tissue gently over the implant”

‘Well what about scarring?’ was the next obvious question.

RM- “I prefer to enter through the underarm because even early in recovery, models can go back to work, it usually fades to undetectable, and models retain the ability to do beautiful topless work without visible scars.”

‘Dr. Maercks this sounds so incredible! Why doesn’t everyone do it this way’ I quickly asked.

RM- “I ask myself the same question all the time” (he said with a grin and a chuckle.) “ I think there is a disconnect between women’s desires and the consensus view of success in plastic surgery and there are clearly people with different wishes. To be honest, women are generally happy with breast augmentation no matter what technique is used. There are certainly patients that want the typical artificial augmentation look, but they are not my patient population. When I get a patient that prefers this look and has a significant disconnect from what I think is best for their form I simply refer them to another surgeon. Different strokes for different folks” (he concluded with a friendly smile.)

In conclusion to the interview, the model was more than satisfied with what she’d heard and was readyfor surgery. In my personal opinion, plastic surgery is not the enemy when itcomes to enhancing the fashion forward career of modeling. The choices are crucial in defining the image of your body and your career’s outcome. Dr Maercks is a clear example of how the art of plastic surgery should be applied with more than a mechanical type of design, not only for models but for everyone who seeks a natural result than can only be met with the rare combination of a surgeon and an artist.

Are all lasers created equal?

New devices such as TITAN, ReFirme, Thermage and Ultherapy are commonly grouped into the category of aesthetic laser devices.  However, these devices use a variety of different technologies to deliver results.  Potential patients must be wary of the differences and the type of results that they can expect.

Devices that use Radiofrequency and Ultrasound energy ( Thermage, Refirme and Ultherapy), seem to appear and disappear with an incredible frequency.  Dr. Maercks does not recommend using these techniques on or near the face and recommends extreme caution elsewhere in the body.  Unfortunately deep heating of the face reduces facial fat (required for a youthful appearance) and produces abnormal deep scarring, what industry leaders want you to believe is ‘healthy collagen production.’  The biggest problem with deep heating of facial tissues is that it causes a relatively uncontrolled concentric contraction of the deep facial tissues.  From a plastic surgeons perspective, this is a recipe for disastrous aesthetic consequences.  These modalities are commonly used by practitioners outside the field of plastic surgery who focus largely on the cheek area.  What results is irregular scar build up(called ‘collagen production by manufacturers), and because of the concentric contraction, problems can occur with eyelid distortion and malfunction, irregular and unnatural mouth appearance and ablation of the natural concavities and convexities that make the human face attractive.   The lines of tension in a natural beautiful face change in direction and tension throughout the face and thus, are the focal point of a beautiful facelift.  Even more unfortunate is the fact that most of these results occur months to a year after the procedure.  The time lag and severity of problems leads patients to seek a different practitioner for correction.  The well meaning original practitioners never learn of these consequences they have produced and continue to believe they are delivering safe improvements.  Dr. Maercks has seen many of these consequences and has tackled their difficult correction with fat transfer, facelift and other procedures.  For these reasons Dr. Maercks focuses on controllable modalities with limited complication profiles.

Use of infrared light(TITAN, High filter BBL, Skintyte) can be used safely to gently tighten the dermis(deep layer of the skin) delivering modest improvements in skin laxity.  The trouble starts when practitioners use these modalities in patients with significant skin laxity to ‘avoid surgery.’  Simply put, there are limitations to the amount of skin tightening that can be safely achieved.  Unfortunately what this means is that the patients who do best with these modalities are the patients who need it the least.  Dr. Maercks believes that Infrared light can be used to gently improve skin tone and appearance in patients with minimal laxity. However, using these modalities to replace a facelift will only result in the need for a complicated ‘reconstructive facelift’ in the future.

The best noninvasive results are achieved by precisely controlling treatment to the superficial skin, the superficial dermis( mid-skin) and the deep dermis/sub dermal border (deep skin).  In this manner a treatment can be completely customized for each patient and significant improvements in superficial appearance/radiance, deep thickness or apparent fullness, and skin tightening.

Dr. Maercks bases the treatment decisions on the amount of ‘down time’ the patient can tolerate, the qualities of the patient’s skin and the superficial appearance of the patient’s skin.  For a zero down time treatment, Dr. Maercks prefers Intense Pulsed light(IPL) or Broad Band Light(BBL) which can be tailored for multiple conditions including acne, rosacea vascular lesions and pigment problems.  With these technologies a quick true ‘lunch-break’ treatment can be delivered with excellent results.

When redness can be tolerated for at least 2 days or more, Dr. Maercks prefers using Erbium laser delivered deep through the skin with a fractionated beam allowing only 6-15% of the skin to be treated.  Because the Erbium laser can be precisely controlled, a much deeper and significant treatment can be delivered with minimal downtime compared with the relatively difficult to control CO2 laser that became so popular in the past.  CO2 lasers cause extensive coagulation, leaving behind less healthy tissue to heal and causing significantly prolonged redness at comparably energy.  Once treatment goals are determined the Profractional Erbium laser beam is tailored to the patient and is usually combined with either BBL/IPL modalities or with a second complete facial Erbium non-fractional treatment tuned to only affect the most superficial layers of the skin.  In this way a completely customizable superficial and deep rejuvenation and skin tightening treatment is delivered.

Thermage®

Thermage can be applied to the face, body and eye areas for targeted collagen tightening. The aging process causes collagen in your skin to break down, resulting in wrinkles and sagging skin. With, Thermage uses patented radiofrequency (RF) technology to heat the deeper layers of your skin, stimulating existing collagen and promoting new collagen growth.

ReFirme®

ReFirme uses special elōs technology, a combination of bi-polar radiofrequency and light energy that heats the dermal tissue within the targeted treatment area. By stimulating collagen production, ReFirme produces a strong effect in lax skin.

TITAN®

TITAN can be used to heat the dermis deep beneath your skin’s surface, thereby tightening the skin of the face, abdomen, arms and more.  The doctor evenly applies infrared light to the dermis, while protecting the skin surface with a special cooling hand-piece. Patients of any skin type or age can be treated.

Ultherapy®

Ultherapy is a new procedure that uses micro focused ultrasound energy to penetrate deeply into the tissue layers.

Fractional CO2 Laser

Another option for skin tightening is the popular carbon dioxide laser. In this treatment, your plastic surgeon directs a grid pattern of tiny light pulses at your skin. Each pulse delivers a column of energy that reaches the dermal layer, stimulating a natural renewal process of collagen.  Unfortunately CO2 lasers create a large amount of heat and the region of coagulation spreads beyond the laser channels, causing a prolonged recovery of weeks of redness and limiting the power that can be safely delivered.

Profractional Erbium laser

The Erbium laser provides the best possible combination of ablative resurfacing and deep dermal contraction resulting in  skin tightening with minimal downtime.  Although patients should expect 2-10 days of redness depending on depth of treatment the profound results to minimal recovery ratio makes this modality the preferred technique of resurfacing and skin tightening.

Using Sciton’s joule and Profile platforms, Dr. Maercks is able to precisely control the treatment intensity, depth, percentage of treated area and even the amount of coagulation so undesirable side effects are minimized and the treatment is custom tailored to each patient.  These platforms also allow the combination of Broad Band Light (IPL) Infrared Light as well as superficial Erbium laser delivery giving patients the best of all worlds for incredible results.

Life after Laser Skin Tightening in Miami

Most non-surgical skin tightening procedures require no downtime. The most common side effect is redness that usually lasts no longer than a few hours. Results will vary depending on the device, as well as factors such as age, number of treatments, severity of conditions and so on.

To learn more about the options in ultrasound, radiofrequency and laser skin tightening in Miami, contact the office of Miami Beach plastic surgeon Rian A. Maercks M.D.