An interview with Lawrence Iteld, MD

Of all the medical disciplines, why did you choose plastic surgery?

During my training, I enjoyed a lot of different fields of medicine. Each appealed to a different part of my personality. Plastic surgery attracted me because it wasn’t about performing a specific operation, but rather about problem solving. When I see the world, when I see patients, I naturally see an outcome, I see a goal, a destiny. The unique challenge of plastic surgery is how to get there.

As a plastic surgeon, we are given a set of tools, and we use those tools in unique combinations to create a result the patient either wants or needs. Since no two people are exactly the same, we have to customize our approach for each and every individual.

What is the best part of being a plastic surgeon?

Plastic surgery is very different from all other surgeries. In every other field, success is measured by curing a disease. In plastic surgery, success is determined by patient satisfaction with their outcome. Nothing is more rewarding then seeing a giant smile on your patient’s face after their recovery—whether for cosmetic or reconstructive surgery.

What are your most difficult challenges of being a plastic surgeon?

Since surgical results are very subjective, on rare occasions, even the best technical result may not satisfy the patient’s expectations.

I spend a lot of time consulting and eliciting patient expectations prior to surgery. But, every once in a while, no matter how hard I try or how good a patient looks, the patient may not be happy.

I am very lucky to have amazing patients and fortunate it is very uncommon that we run into these issues.

What is your surgical style?

Meticulous. Preplanned. Efficient.

My goal is to spend as much time as needed prior to surgery to clearly delineate patient goals so I can perform the procedure efficiently and with as few variables as possible.

How many years of training did it take for you to become a plastic surgeon?

It is a long and continuous educational process. After four years of college, I spent four years in medical school, followed by six years of surgical residency. Many surgeons end their training there. But, I continued with a one-year fellowship in microsurgery.

Learning does not stop after residency and fellowship. It’s a lifelong process that includes participation in national meetings, development with industry partners, and self-directed learning. This is critically important—to stay on top of cutting edge developments within my field, and to provide the highest level of care to my patients.

Which procedures are requested most?

Nationally, the top two cosmetic surgical procedures are breast augmentation and liposuction. This is mirrored within my practice.

Injectable treatments continue to grow in popularity as patients want to maintain a youthful appearance without having surgery.

What’s the best advice you can give a patient who is thinking about having plastic surgery?

Do your homework.

There are great resources available for patients to get introductory information that allows them to have a well-framed discussion at their consultation.

I also recommend obtaining more than one consultation, but make sure you go to a board certified plastic surgeon. “Cosmetic surgeons” do not have the depth of training required to become a plastic surgeon. Always looks for the American Board of Plastic Surgery (https://bit.ly/2Olsoil)

How do you handle a patient who comes to you with unrealistic expectations?

We have discussions to try to detail their goals. If I don’t believe what they want is obtainable, I frankly tell them that. Ultimately, I tell them I’m not a good match for them.

After all, in plastic surgery, success is measured subjectively.

When not working, what do you do for fun?

Staying fit is important to me. I work out most days of the week. I love to spend time with my family, and my dog, Cadence!

Have questions you want answered anonymously?

I am a frequent contributor to RealSelf.com. You’re welcome to post questions there for general responses. Obviously, I can’t give specific answers; for that, you’ll want to come in for a private and completely confidential appointment to address your particular issues.

Located in Chicago’s Lincoln Park, our offices are a warm, friendly and comfortable place to share your wants, needs and concerns.

You work out, but your stomach is still flabby. Why is that? Have you gained weight? Lost weight? Had babies? Have no idea what gives? You don’t have to be unhappy with how your belly looks.

Let’s talk about three options for men and women to help fix whatever the reason your abdomen isn’t as tight and flat as you want it to be.

CoolSculpting

CoolSculpting is the effective FDA approved nonsurgical way to eliminate stubborn fat. The procedure safely delivers precisely controlled cooling that gently and effectively targets fat cells underneath the skin. Treated fat cells are crystallized (frozen), then die. Over time, your body naturally processes and eliminates these dead cells, leaving a more sculpted you. Best of all, there is no surgery, no anesthesia, no invasive techniques, and little to no downtime.

It’s important to remember that CoolSculpting is not a weight-loss solution. Good candidates are patients who have noticeable bulges they’d like to make go away. Many of my patients choose CoolSculpting when they want a nonsurgical alternative to liposuction or a tummy tuck.

Most patients achieve an average of up to a 20% fat reduction per treatment. You can expect to see really good results within 3–4 weeks, with continuing improvements over the next couple of months. The number of CoolSculpting cycles you’ll need depends on the results you want to achieve.

But, if you want more fat reduction in less time, think Lipo!

Liposculpture/Liposuction

If you work out regularly but still have fat deposits that are resistant to diet and exercise, and have either tried or need more than CoolSculpting, Lipo might be the right option for you.

Call it what you will, liposculpture and liposuction refer to a body sculpture technique that removes superficial fat deposits to improve body contour and reduce size. In refining your shape, it can help you look thinner and more fit. It is definitely not a treatment for obesity nor a substitute for proper diet and exercise.

Typically, lipo is an outpatient procedure that, depending on the nature of the procedure, can be safely performed using local anesthesia, intravenous sedation or, when necessary,  general anesthesia. Most patients usually need only one treatment to reshape their tummy and have predictable results.

Keep in mind that it’s not an effective treatment for loose saggy skin. If that’s your issue, consider a tummy tuck.

Tummy Tuck

Even if you now have normal body weight and proportions, there are several reasons for a protruding or loose, sagging belly. The most common causes include pregnancy, age, heredity, prior surgeries, and weight fluctuations. That’s why tummy tucks are so popular for men and women.

Sometimes there is an increase in fat of the abdominal wall, and you didn’t have to go through pregnancies for this to be the case. Usually, if you have some degree of excess skin or laxity and a separation of the abdominal muscles, it may be time to consider a tummy tuck.

A tummy tuck, also known as abdominoplasty, removes excess fat and skin and, in many cases, repairs the weakened or separated muscles. The surgery helps create an abdominal profile that is smoother and firmer. I often combine it with lipo to fine tune the procedure and give patients better results.

Pain? I believe in preventing it before, during and after surgery using our non-opioid protocol, so you’ll have a much better experience.

Remember that this is surgery, performed under general anesthesia, and requires a week or so to recover following the procedure. A tummy tuck cannot correct stretch marks, though these may be removed if the stretch marks were on the excised skin.

The bottom line

None of these procedures is a substitute for weight loss or an appropriate exercise program. We recommend your coming in for a consultation, so we can help you identify what would give you the best results. Call and schedule a consultation 312.757.4505 or send us an email at info@driteld.com.

Have questions you want answered anonymously?

I am a frequent contributor to RealSelf.com. You’re welcome to post questions there for general responses. Obviously, I can’t give specific answers; for that, you’ll want to come in for a private and completely confidential appointment to address your particular issues.

Located in Chicago’s Lincoln Park, our offices are a warm, friendly and comfortable place to share your wants, needs and concerns.

I can’t even count the number of times a patient has asked me “do I need a facelift?”

My usual response, as it is for any question about whether someone should have surgery, is “what makes you unhappy about your looks?”

• If there are a few wrinkles or imperfections that bother you, there are now many nonsurgical options to consider before taking the leap of having a facelift.
• If nonsurgical or a minimally invasive procedures are no longer adequate, and you’re still not happy with how you look, then by all means, let’s talk surgery.

Let’s look at your options:

A few wrinkles or imperfections bothering you? No matter your age, you may have a few unwanted wrinkles or imperfections that you wish were gone. Poof! Like magic, we can make that happen.…at least temporarily.

Active Lines

These may or may not be age related. No matter the cause, there are many injectable and filler options:

• Neurotoxins, such as Botox, temporarily weaken the muscle(s) causing wrinkles. Patients usually set up a schedule for having their injections every 3–4 months.
• Fillers are a great way to restore lost volume or correct structure. I also use fillers to smooth out skin, augment areas, such as lips, cheeks, chin, and so much more. These products last 6 –24 months.

More Nonsurgical Fixes

We can turn back time and delay the need for a surgical option with one of these amazing rejuvenation treatments:

• Profound RF reverses multiple signs of aging, including effectively toning lax skin and creating dermal volume, with just one in-office treatment.
• Sublative promotes collagen production using fractionated bi-polar radio frequency with no downtime.
• By combining radio frequency and light energy, Sublime reduces fine wrinkles, improves facial contours, and skin quality.

Minimally Invasive

Do you want more than a nonsurgical procedure but still not ready for a facelift? There is another option—Silhouette InstaLift. This in-office, minimally invasive breakthrough anti-aging treatment lifts the deeper layers of the skin in the mid-face or cheek area. It is a natural-looking way to redefine facial contours, and a great way to achieve a more youthful appearance.

Time to talk surgery

If your face is showing signs of aging and none of the other options seem adequate to accomplish your goals, it may be time for us to talk about a facelift.

Having a facelift is the surgical way to address sagging skin, deep creases and volume loss that contribute to an aged facial appearance. This procedure does more than lift and trim the sagging skin. I actually lift the underlying the muscle and tissue, which ultimately puts less tension on the skin.

Keep in mind that the best facelifts give a refreshed, younger look. The last thing you’d want is to look overly tightened and pulled. The good news is that a facelift can offer dramatic and excellent results.

Since this is surgery, you will have some down time following a facelift. It could take you about two weeks to get back to your normal daily routine. Additionally, it may take up to a year for all residual swelling, bruising and changes in skin sensation to resolve.

Let’s start the discussion

We are here for any and all your needs. Call and schedule a consultation 312.757.4505 or send us an email at info@driteld.com.

Have questions you want answered anonymously?

I am a frequent contributor to RealSelf.com. You’re welcome to post questions there for general responses. Obviously, I can’t give specific answers; for that, you’ll want to come in for a private and completely confidential appointment to address your particular issues.

Located in Chicago’s Lincoln Park, our offices are a warm, friendly and comfortable place to share your wants, needs and concerns.

Women who have breast cancer have many difficult decisions to make along the way. If one of those is decide if breast reconstruction is right for you, and it is, you’ll need to evaluate which technique you prefer.

There are three main ways to reconstruct the shape of your breast or breasts:

• Use breast implants.
• Use your own tissue, known as a flap procedure.
• Combine a flap with implants.

Let’s look at the various options available to patients wanting breast reconstruction.

Breast Reconstruction Using Implants

Most women who choose reconstruction with implants do well. There are several advantages of reconstruction done using implants.

• We can do it at the same time as your Mastectomy, or start when you have your surgery and then complete later.
• There is only one surgical site.
• You can choose for your reconstruction the size and shape.

For women who choose to delay reconstruction, I often put in a short-term tissue expanders during the mastectomy to help prepare for reconstructive surgery later.

Flap Procedures

Flap procedures use tissue from other parts of your body, such as your tummy, back, thighs, or buttocks to rebuild the breast shape. Tissue flaps usually look more natural and behave more like natural breast tissue than implants.

• When doing a TRAM (transverse rectus abdominis muscle) flap, I use tummy tissue. In this case, there are two types: Pedicle flap, where the flap remains attached to the original blood supply; and Free TRAM flap, where I completely remove and move the tissue up to the chest.
• For the DIEP (deep inferior epigastric perforator) flap, I take the fat and skin from the same area as the TRAM flap but not the muscle to form the breast.
• For the gluteal free flap or GAP flap, I use tissue from the buttocks to create the breast.
• Another option is the transverse upper gracilis flap or TUG flap. In this case, I use muscle and fatty tissue from along the bottom fold of the buttock extending to the inner thigh.

Advantage of Flaps

In addition to flaps feeling more like natural breast tissue, flaps will enlarge or shrink if you gain or lose weight. And, while breast implants sometimes need to be replaced, this is not a concern with flaps.

Disadvantage of Flaps

Keep in mind that flaps require more surgery and a longer recovery than implants. After all, there are two surgical site and two scars.

Breast Reconstruction Options

“Hybrid” Approach

With the Hybrid Reconstruction approach, I rebuild the breasts with live fat combined in a single stage with breast implants. This technique gives added size and projection to the new breasts when a single donor site tissue transplant is not enough. Effectively, patients have breast augmentation and reconstruction all in one surgical procedure.

Fat grafting

Have you already had reconstruction, but aren’t happy with the shape of your breasts? Using liposuction, I harvest fat from another part of the body (e.g., buttocks, thighs, or tummy) and transfer it to the reconstructed breast to help fix your breast shape. Fat is really useful for fine-tuning the reconstruction for getting the breast as smooth as possible.

3D Nipple Tattooing

I am pleased to work with a very talented tattoo artist who uses 3D tattooing to create an image of a nipple on the skin. Although actually flat, it is amazingly realistic looking.

Many Considerations

There is much to think about when approaching all the options for breast reconstruction. We are here to answer your questions and help you navigate the entire process. Please contact my patient coordinators to schedule an appointment. Call 312.757.4505 or send us an email at info@driteld.com.

Have questions you want answered anonymously?

I am a frequent contributor to RealSelf.com. You’re welcome to post questions there for general responses. Obviously, I can’t give specific answers; for that, you’ll want to come in for a private and completely confidential appointment to address your particular issues.

Located in Chicago’s Lincoln Park, our offices are a warm, friendly and comfortable place to share your wants, needs and concerns.

An interview with Dr. Iteld

Dr. Iteld has been working with a lobbyist group to promote and encourage an initiative to expand the Centers for Medicare & Medicaid Services (CMS) payments for non-opioid drugs. Here is an interview with him about these efforts:

You recently participated in meeting on Capitol Hill.  With whom did you meet?

We met with policy advisors and legislative aids at the White House, members of the Senate and the House of Representatives.

What was the purpose of that meeting?

Our purpose is to expand CMS compensation to hospitals for the use of non-opioid medication in peri-operative settings.

Why has this become such an important issue?

There are many non-opioid medications that can be used during surgery to reduce or eliminate the need for opioids during the first several days of recovery. After that time, the need for opioids is minimal or unnecessary in most situations.

Prior to 2015, Medicare reimbursed hospitals for these medications on a case-by-case basis. Because of this, usage increase by more than 200% between 2013 and 2015. In 2015, CMS included these medications, including Exparel, in the “surgical bundle.” Due to this move, the usage stabilized or declined over the subsequent two years.

The medication is far from exorbitantly priced. We are talking about a medication that costs $300 and only requires a single dose. However, many hospitals now limit or even restrict availability due to bundled payments.

What is changing that it’s an issue now?

For calendar year 2019, CMS is recommending unbundling reimbursement to ambulatory surgical centers, but has not made a final decision about Outpatient Prospective Payment System (OPPS) done in a hospital setting.

The reason we are taking the issue to Capitol Hill is because “outpatient” means a stay of less than 48 hours. So many procedures that can be done with an overnight stay — for example, joint replacements, and some cancer procedures, as well as innumerable other surgeries — would be excluded from this medication and opioid usage would continue.

What did you hope to accomplish?

Our goal for the trip was to encourage and elicit support from the White House and legislators to expand CMS payments to include these procedures.

We are NOT trying to take opioids away from patients with chronic pain or in hospice settings. We want to increase the availability and awareness of opioid-sparing techniques for acute surgical procedures.

You advocate for non-opioid surgery. Would you please expand on that?

Many surgical procedures are often an initial exposure, which can lead to dependence, some times as high as in 20% of patients. While most patients never become long-term users, there are many studies showing that up to two-thirds of prescribed pain pills are not used following surgery. It is these very pills that wind up on the streets and in our children’s hands, and are the core of the opioid crisis.

The opioid epidemic took a generation to develop and will not be solved overnight. Our belief is that this is an important starting point, and we hope that Washington incorporates opioid-reducing techniques into its overall strategies.

What are the next steps?

Our hope is that CMS will include OPPS for 2019, and then we can work toward in-patient procedures for 2020.

Since most commercial and state insurance programs follow CMS guidelines, we will look to work with surgical and anesthetic societies to educate their members about best practices for opioid reduction, increase patient awareness, and implement direct-to-consumer awareness tactics.

A final note:

We have gone opioid-free for most procedures in my practice. This protocol provides equivalent or better pain control than relying on opioids, and offers a better patient experience. I encourage other surgeons to do the same.

Have questions you want answered anonymously?

I am a frequent contributor to RealSelf.com. You’re welcome to post questions there for general responses. Obviously, I can’t give specific answers; for that, you’ll want to come in for a private and completely confidential appointment to address your particular issues.

Located in Chicago’s Lincoln Park, our offices are a warm, friendly and comfortable place to share your wants, needs and concerns.