Question 1

What is Dr. Baumholtz's perspective on Croton Phenol Peels?

Accepted Answer

Dr. Baumholtz considers the croton phenol peel the gold standard for chemical peels and highly effective for skin rejuvenation in appropriate patients. However, it is the most intense peel, requires cardiac monitoring, and involves substantial downtime, often keeping patients out of the public eye for a long time. It is essentially a significant chemical burn to the face and can cause tremendous damage, especially in darker skin patients in South Texas. He strongly recommends it only be performed by highly skilled medical doctors with years of experience, and does not recommend it for the average person or practitioner.

Question 2

What are Dr. Baumholtz's recommendations for BBL alternatives for patients who are too skinny?

Accepted Answer

For patients deemed too skinny for a traditional BBL, options are limited. Dr. Baumholtz advises against gaining weight solely for BBL fat harvesting, as this fat is likely to be lost, diminishing results. He states that a 'skinny BBL' is not a real or viable procedure, and successful BBL candidacy depends on sufficient existing fat. While off-the-shelf injectable products exist for buttock augmentation, he is hesitant about injecting high-volume artificial material. Buttock implants are an option, but are better for projection than overall shape. He also notes that a tummy tuck can help highlight the curve over the hips.

Question 3

How does BMI impact surgical candidacy, and what support does Dr. Baumholtz offer?

Accepted Answer

BMI is a crucial factor in patient candidacy and surgical outcomes. Dr. Baumholtz emphasizes that a BMI above 35 is closely associated with complications across the board. For patients concerned about their BMI, the practice offers support for weight loss using medications like Glutide, 2-Zepatide, or oral Zepan.

Question 4

When is a breast lift recommended in conjunction with breast augmentation?

Accepted Answer

Dr. Baumholtz advises that if breasts are significantly low, a breast lift should be performed concurrently with breast implants. Failing to do so will result in 'big, saggy boobs,' as an implant alone is typically insufficient to solve the issue, especially for women with significant excess skin and volume repositioning due to weight loss (e.g., from GLP-1 drugs). He notes that if breasts are significantly low, it's likely other body areas may also require lifting.

Question 5

What is Dr. Baumholtz's approach to achieving 'Yoga Boobs' or a natural breast augmentation?

Accepted Answer

Dr. Baumholtz defines 'Yoga Boobs' or 'Ballerina Boobs' as using smaller implants to achieve a specific aesthetic, like filling out a sports bra, and notes this concept is entirely about a look. His surgical plan is primarily determined by the patient's anatomy (base diameter/breast width) and their desired projection, not his personal aesthetic preference. The goal is to achieve the patient's desired aesthetic look if it is surgically feasible, creating the most realistic and safest plan possible. For a low projection look, it's a combination of existing breast tissue and the implant. He uses low-profile implants for a low-profile look, and moderate profiles for those with very little natural tissue desiring a specific outcome. Implant height is determined using patient pictures and 3D modeling.

Question 6

What should patients expect regarding post-surgical numbness?

Accepted Answer

In almost every surgery, patients will experience a period of numbness around the incision, which may extend above and below it. Some of this numbness will be permanent, and the scar itself can remain numb or dull even if surrounding areas regain normal sensation. Sensory nerves may be damaged during surgery, with brachioplasty (arm lift) being a common example where a patch of numbness can occur. In such scenarios, numbness is preferable to constant electrical pain. While numbness generally improves with time, if no improvement is seen, it's usually a fixed defect. The practice rarely performs reconstructive surgery or reroutes nerves solely for sensation.

Question 7

What is Dr. Baumholtz's approach to buccal fat removal?

Accepted Answer

Dr. Baumholtz approaches buccal fat removal with caution, as it may not be right for everyone. While it can be a straightforward operation with a thorough understanding of anatomy, it involves inherent risks due to encountering major nerves, vessels, and salivary gland tubes in the cheek. A significant long-term complication is the development of hollowing in the cheeks as a person ages, which is very challenging to correct. He notes that with the rise of GLP-1 drugs, many people no longer need this procedure as their faces slim out with weight loss. For patients at an ideal weight who still desire less fullness, he might initially recommend Botox in the masseters for facial slimming, considering buccal fat removal as a later option for facial balancing.

Question 8

How do previous facial treatments impact a future facelift?

Accepted Answer

Many previous facial treatments can compromise the results of a future facelift. Dr. Baumholtz explains that procedures like threads and energy devices typically cause significant scarring under the tissues, making repositioning or re-draping during a facelift very challenging. Certain injectable products, such as Kybella for submental fat, also produce scarring that makes the treated area difficult to manipulate. A study showed that permanent fillers can clog microcirculation, leading to serious wounds and vascular issues during facelifts, making healing outcomes unpredictable. He emphasizes the importance of disclosing all previous treatments, as he has encountered unmentioned embedded threads or other substances that complicate operations.

Question 9

What is involved in an areola reduction procedure?

Accepted Answer

Dr. Baumholtz performs areola reduction using a technique that involves marking the desired smaller areola size, removing the skin between the original and desired areola, and then performing a 'wagon wheel type repair' to evenly pull the circles together. He states it's a very safe operation and can be performed under local anesthesia ('non-medicine'), especially if a submuscular implant is present, due to multiple layers of tissue separating the surgical area from the implant.

Question 10

What exactly does the term 'Yoga Boobs' refer to in breast augmentation?

Accepted Answer

Dr. Baumholtz defines 'Yoga Boobs' or 'Ballerina Boobs' as using smaller implants to achieve a specific aesthetic, like filling out a sports bra, and notes this concept is entirely about a look. His surgical plan is primarily determined by the patient's anatomy (base diameter/breast width) and their desired projection, not his personal aesthetic preference. The goal is to achieve the patient's desired aesthetic look if it is surgically feasible, creating the most realistic and safest plan possible. For a low projection look, it's a combination of existing breast tissue and the implant. He uses low-profile implants for a low-profile look, and moderate profiles for those with very little natural tissue desiring a specific outcome. Implant height is determined using patient pictures and 3D modeling.

Question 11

What is the procedure for an areola reduction, and what kind of scarring can be expected?

Accepted Answer

Dr. Baumholtz performs areola reduction using a technique that involves marking the desired smaller areola size, removing the skin between the original and desired areola, and then performing a 'wagon wheel type repair' to evenly pull the circles together. He states it's a very safe operation and can be performed under local anesthesia ('non-medicine'), especially if a submuscular implant is present, due to multiple layers of tissue separating the surgical area from the implant.

Question 12

What is the typical recovery time and process for a deep phenol peel?

Accepted Answer

Dr. Baumholtz considers the croton phenol peel the gold standard for chemical peels and highly effective for skin rejuvenation in appropriate patients. However, it is the most intense peel, requires cardiac monitoring, and involves substantial downtime, often keeping patients out of the public eye for a long time. It is essentially a significant chemical burn to the face and can cause tremendous damage, especially in darker skin patients in South Texas. He strongly recommends it only be performed by highly skilled medical doctors with years of experience, and does not recommend it for the average person or practitioner.

Question 13

What are the specific long-term concerns or risks associated with buccal fat removal?

Accepted Answer

Dr. Baumholtz approaches buccal fat removal with caution, as it may not be right for everyone. While it can be a straightforward operation with a thorough understanding of anatomy, it involves inherent risks due to encountering major nerves, vessels, and salivary gland tubes in the cheek. A significant long-term complication is the development of hollowing in the cheeks as a person ages, which is very challenging to correct. He notes that with the rise of GLP-1 drugs, many people no longer need this procedure as their faces slim out with weight loss. For patients at an ideal weight who still desire less fullness, he might initially recommend Botox in the masseters for facial slimming, considering buccal fat removal as a later option for facial balancing.

Question 14

What are the best alternatives for someone who is too skinny for a traditional BBL?

Accepted Answer

For patients deemed too skinny for a traditional BBL, options are limited. Dr. Baumholtz advises against gaining weight solely for BBL fat harvesting, as this fat is likely to be lost, diminishing results. He states that a 'skinny BBL' is not a real or viable procedure, and successful BBL candidacy depends on sufficient existing fat. While off-the-shelf injectable products exist for buttock augmentation, he is hesitant about injecting high-volume artificial material. Buttock implants are an option, but are better for projection than overall shape. He also notes that a tummy tuck can help highlight the curve over the hips.

Question 15

Why is BMI so crucial for surgical candidacy and outcomes?

Accepted Answer

BMI is a crucial factor in patient candidacy and surgical outcomes. Dr. Baumholtz emphasizes that a BMI above 35 is closely associated with complications across the board. For patients concerned about their BMI, the practice offers support for weight loss using medications like Glutide, 2-Zepatide, or oral Zepan.

Question 16

How long does post-surgical numbness typically last, and is it ever permanent?

Accepted Answer

In almost every surgery, patients will experience a period of numbness around the incision, which may extend above and below it. Some of this numbness will be permanent, and the scar itself can remain numb or dull even if surrounding areas regain normal sensation. Sensory nerves may be damaged during surgery, with brachioplasty (arm lift) being a common example where a patch of numbness can occur. In such scenarios, numbness is preferable to constant electrical pain. While numbness generally improves with time, if no improvement is seen, it's usually a fixed defect. The practice rarely performs reconstructive surgery or reroutes nerves solely for sensation.

Question 17

What does Dr. Baumholtz say about what they specialize in?

Accepted Answer

Later this week, we're going to do an areola reduction here in the office.

Question 18

What does Dr. Baumholtz say about their techniques?

Accepted Answer

Well, we set our mark as to what size we would like the areola to be. We then remove the skin between the outside of the original areola and the gold areola for what we want. And then it is a, what's known as a wagon wheel type repair. And so when we go to tighten this, when we go to tighten the threads, it's going to pull the two circles together evenly and distribute that tension around the circle. The technique applied by the doctor for circumareolar lift or areola reduction is the same. Generally, a smaller implant is used to achieve a smaller overall breast look.

Question 19

What does Dr. Baumholtz say about their training and credentials?

Accepted Answer

Hi, I'm Dr. Mike Baumholz, I'm a board-certified plastic surgeon in San Antonio and I perform face and neck lifts. Dr. Baumholtz is a double board-certified surgeon.

Question 20

What does Dr. Baumholtz say about safety?

Accepted Answer

We want you to reach your aesthetic goals as safely and smoothly as possible. Very safe because there are multiple layers of tissue between where we're working and where that implant is sitting.

Dr. Michael Baumholtz, MD, FACS

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