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All posts by Timothy Janiga

Best of 2015: Plastic Surgeries of the Year


As we near the end of 2015, let’s take a closer look at the three most common cosmetic procedures I performed for patients this year: breast augmentation, facelift and rhinoplasty.

These three are some of the most commonly performed surgical procedures in the United States. Here at Janiga MDs, we seem to follow the national trend with these procedures outpacing most others.

The national numbers for 2015 won’t be out for a couple of months, but breast augmentation was one of the most popular procedures in 2014 according to the American Society of Plastic Surgeons (ASPS), with almost 300,000 augmentations performed across the country. This number is even greater when you include those women who have a breast lift along with augmentation, which is one of the most common procedures we performed at Janiga MDs in 2015. Breast augmentation is a procedure that places either saline or silicone implants in the chest wall to increase breast size. The implant can be placed either above or below the muscle, depending on the patient’s anatomy. The procedure can enhance a naturally smaller breast to make a woman feel more symmetrical. Also, the procedure can help women’s clothes fit nicer and increase overall self-esteem. Breast augmentation can improve breast appearance after pregnancy, nursing or weight loss. Overall, breast augmentation is a very high satisfaction procedure and this is reflected in the feedback we get from patients who elect for these types of services from Janiga MDs.

The next top procedure is the facelift. In 2014, ASPS reported nearly 150,000 facelifts were performed nationally. This number has remained mostly stable for 15 years, and it remains one of the most common procedures I perform. There are two main types of facelifts in my practice; one is the in-office facelift or mini facelift, and the other is the full facelift performed in a surgical center. In my practice, I perform an equal number of each type of facelift. The in-office facelift/mini facelift is performed under local anesthesia, which means you’re not put to sleep. This procedure is for women with excess skin around the jowl and neck area who are not ready for a full facelift in the operating room.

When under general anesthesia, you have more options, including a more extensive facelift and neck lift. Liposuction of the neck, brow lift or eyelid procedures can be performed at the same time. In some cases, body procedures such as breast augmentation can be performed in the same surgical session.

The last of the three most popular procedures is rhinoplasty. Rhinoplasty is one of my favorite procedures to perform. It is done to reduce the size of the nose, change the angle of the tip, remove a hump on the nose’s dorsal surface or any combination of the three. If done well, rhinoplasty can provide tremendous satisfaction to patients.

As we reflect back on 2015, we would like to say thank you to all of our patients. It has been a great year. As always, feel free to reach out to us for a free consultation at our Reno office.

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Considering a Mommy Makeover?

Give yourself the gift of confidence this holiday season with a mommy makeover.mommy-makeover

As parents, we give our children every ounce of our time and energy around the holidays, just as we give them all throughout the year. One of the most common obstacles to having surgery is finding the time to devote to yourself. Although this is a problem for both men and women, the data shows women do the majority of the caretaking of the household and of the children, so it doesn’t surprise me (or probably you as the reader) that finding time for surgery is very difficult for mothers. If you are like my wife, it’s “go-go-go” from sunup to sundown. I am encouraging you – as I encourage her – to take time for yourself. Schedule it and find a way to do it, because it’s worth the effort.

A mommy makeover entails two main procedures, with one involving the breasts and the second involving the stomach. For the breast portion of the surgery, some women need breast augmentation while others need a lift or lift with augmentation. This depends on the anatomy and how the breast has changed with pregnancy and/or nursing. You can opt for a mini tummy tuck or a full tummy tuck, but I’ve found that a majority of women choose the full tuck after pregnancy. The mommy makeover must be performed in a surgical center under general anesthesia. The surgery takes between three and five hours. The downtime associated with the mommy makeover is between one and three weeks, depending on the procedures performed. Additionally, you should refrain from lifting anything greater than 20 pounds for six weeks afterward.

While it is true that a mommy makeover requires some downtime, it is our experience that the amount of help needed in those first few weeks after surgery is far outweighed by the boost in self-esteem and confidence that the women in my practice gain after a mommy makeover.

This year, make some “me time” and boost your self-confidence so you have more to give of yourself in the years to come. As always,

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Breast Reduction for Males – Learn More About Gynecomastia

In November, I am focusing on the cosmetic procedures that are most utilized by men. One of the most common is gynecomastia surgery.


Gynecomastia in men occurs in two main forms. The first is in younger men, where a small amount of breast tissue develops as a result of hormones. This usually does not bring any medical consequences, but becomes cosmetically unacceptable in its appearance. The second type of gynecomastia surgery in men is for excess skin or fatty tissue after weight loss or gain. When performed surgically, both procedures are similar, but the hormonal type of gynecomastia is usually performed on younger patients and is a smaller procedure then the post-weight loss or gain type of gynecomastia surgery.

Most of my gynecomastia patients come in saying that they don’t like the way the chest area looks with their shirt off, and some even have what they consider to be an unacceptable appearance while clothed. The goal of gynecomastia surgery is to remove the excess breast tissue, fat or skin to give the male chest a more masculine appearance.

The procedure takes approximately one to two hours in the operating room depending on how extensive, and the recovery is one to three weeks.

Please call my office to schedule your complimentary consultation if you are interested and cosmetic gynecomastia surgery.

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Growing Popularity in Plastic Surgery for Men – What Are the Trends?

According to a report from the American Society of plastic surgeons, there were 15.6 million cosmetic procedures in 2014. Of these procedures, 1.7 million were surgical and 13.9 million were considered minimally invasive. We talk a lot about cosmetic procedures for women, but for November, we’re going to focus some attention on the other half of the population: men.

The top five cosmetic surgical procedures for men in 2014 were nose reshaping, eyelid surgery, breast reduction, liposuction and facelift. The top five minimally invasive procedures include Botulinum Toxin Type A (Botox, Dysport, or Xeomin), laser hair removal, microdermabrasion, chemical peels and fillers.



From a surgical perspective, nose reshaping or rhinoplasty can be performed in most age groups and is usually a procedure done to improve the overall contour or size of the nose. The width length or a type of dorsal hump can be improved with rhinoplasty. Eyelid surgery candidates are usually a more mature population, who seek help with laxity in the skin on the upper eyelid or bags or laxity on the lower eyelid. Breast reduction in men can be performed after massive weight loss or in men with abnormal tissue called gynecomastia. Liposuction is the fourth most common procedure performed on men. It can be performed on the flanks or abdomen to reduce fat deposits. Rounding out the top five is facelift, which is a similar procedure for men and women, but special care must be taken in men because of their hairline.

For minimally invasive procedures, the overwhelming top spots goes to the botulinum toxin type A with more than 400,000 men receiving this procedure in 2014. Botulinum toxin inhibits muscle movement and is commonly performed to decrease lines in the area between the eyes, the forehead and around the eyes on the sides. Other areas that can be treated include the jaw muscles, which can be prominent in men. Botulism toxin can be used to inhibit some of the muscle contraction in this area, thereby decreasing the thickness of the muscle improving the contour of the face. Laser hair removal is usually performed on the beard area or other areas such as the back where hair is undesirably located. Microdermabrasion and chemical peels are usually performed by an esthetician associated with a plastic surgeon or dermatologist. Rounding out the top five are soft tissue fillers. Men with a desire for improving the lines around the mouth, or giving a lift to the cheek area are interested in soft tissue augmentation such as Juvéderm, Restylane or Voluma.

I’ve included a few before and after pictures specifically for men, but if you would like a consultation for any of these surgical or minimally invasive procedures, please call our office at 775-398-4600 and make an appointment for your complementary consultation.

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Are you a good candidate for breast revision surgery?


There are many reasons to have revisional surgery for the breasts. Having previous breast augmentation, breast lift, breast reduction, or surgical procedure such as breast biopsy or lumpectomy may make you a candidate for a revision.

Breast augmentation revision can be performed for patients who would like a different size implant or a switch between saline and silicone. These procedures can also be performed for someone who may want to switch out a silicone implant for one of the new gummy bear silicone implants. Over time, the concept of ideal breast appearance can change for an individual. As women mature, their bodies change. Additionally, women may decide they want the breast to be smaller or larger. This is the most common reason for breast revision surgery after breast augmentation.

If you have had a previous breast lift, you may choose to have revisional surgery years later. As gravity has a continued effect on the breast itself, some people want to have their breasts lifted again. As women mature, have children, breast feed, have hormone changes and gain or lose weight, the breasts go through significant changes. Additionally, as women go through menopause, the dense breast tissue changes to a less firm fatty tissue adding to the sagginess of the breast. Another reason for revisional surgery after breast lift may be to improve unwanted scarring. With surgery, there is always a scar. At times, we can improve upon the look of a scar by revising it.

Breast reduction is another reason to have revisional breast surgery. There are many cases of women who have had breast reduction and, as the body changes with pregnancy, nursing, or maturing, they may have enlargement of the breasts again. This is usually related to weight gain or loss but may be a natural hormonal change for some women. A revisional breast reduction can also be performed if there is asymmetry in the breast from a previous procedure. If one breast is larger than the other or one is slightly higher, it can be made smaller or lifted higher.

People will also visit us for breast revision surgery after medical procedures that have been done to or around the breast which cause abnormalities in the contour. Revisional breast surgery can be done to improve the contour irregularities after breast biopsy, lumpectomy or from removal of other skin cancers on the breast.

If you have any questions or concerns regarding revisional breast surgery, please contact me, Dr. Timothy Janiga for your complementary cosmetic consultation.

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Breast Reconstruction Options Explained

In honor of October, which is Breast Cancer Awareness Month, I thought we would review a little bit about breast cancer reconstruction. My practice is about 30 percent breast cancer reconstruction, and I do most types that are available.


Breast cancer reconstruction is the general term for reconstruction of the breast after cancer. It can come in many forms which we will review here.

First, there can be small abnormalities of the shape of the breast after a Lumpectomy. Lumpectomy is done when there is a small focus of breast cancer that needs to be removed. In this case, the entire breast does not have to be removed. Radiation may or may not follow. Lumpectomy scars can be indented or make the breast appear smaller on one side than the other. We use different techniques to give the breast a more natural shape after surgery. Sometimes an implant is needed, but at times we can take fat from another location on the body and graft the lumpectomy area for a more rounded shape. At times, we need only scar revision after lumpectomy to regain a more natural shape.

Breast reconstruction is commonly done after mastectomy on one or both sides. There are multiple techniques for mastectomy and reconstruction. Let’s first discuss the mastectomy. A mastectomy is when the breast tissue is removed either for an occurrence of breast cancer or for the prevention of breast cancer (in genetically susceptible individuals). The overlying skin is left intact and is called the skin flap, but most of the time the nipple/areolar complex needs to be removed as it contains breast tissue. Once your breast surgeon/general surgeon performs the mastectomy, I will usually come in on the same day and perform part of the reconstruction. Please be aware there are times where we are unable to do reconstruction at the same time; this will be determined by you and your doctors.

With most breast cancer reconstruction, a temporary expander is placed under the skin flaps during surgery. The expander is then gradually inflated with saline over multiple weeks after your surgery to stretch the skin out to allow for a larger permanent implant to be placed later. The expansions are done in the office approximately every two weeks. Once the desired size is reached using the expander, you will return to the operating room and have the expanders removed and permanent implants placed. Some women decide this is where they would like to stop, but other women proceed with grafting and tattooing for nipple areolar reconstruction, and sometimes fat grafting for contouring of the breast.

Sometimes, more involved procedures need to be performed for reconstruction that include a latissimus flap where the latissimus dorsi muscle from the back is moved around toward the front to give more volume or coverage. This is particularly needed after a mastectomy that is accompanied by radiation. Radiated tissue is thinner and, at times, we will need more tissue to help maintain as natural of a reconstruction as possible.

Less commonly, but also possible is a TRAM flap for breast cancer reconstruction. This is where tissue from the abdomen is used instead of the back. Your surgeon will have different reasons based on your anatomy for using each type of procedure.

The government has mandated that breast cancer reconstruction be covered under all health insurance plans. This is been in effect for many years. If you have breast cancer in one breast, insurance companies are also mandated to cover a “matching procedure” on the other side to decrease or increase volume so that the reconstructed and natural breast are as close as humanly possible to each other in their appearance.

If you or a loved one has questions about breast cancer reconstruction please make an appointment with me and your breast surgeon to discuss.

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The beauty of a mommy makeover


The mommy makeover is one of the most common procedures plastic surgeons – including myself -perform. The mommy makeover is a combination of breast surgery and tummy tuck to restore the shape of the breasts and stomach to their pre-pregnancy states.

The breast surgery can either be a lift, a lift with implants placed or can involve surgery to the nipple areolar complex if needed. Some women only need the breasts repositioned after pregnancy. The milk engorgement, nursing, hormones and changes that occur for the breasts during pregnancy and nursing can make the breasts feel and look flatter and lower than prior to pregnancy. This is also something that naturally happens as we age, so there can be a combination of factors at play. In this case, a breast lift alone may be the only breast surgery needed.

Sometimes, projection of the breast is the major issue and an implant can be placed under the muscle or on top of the muscle to regain some of the projection of the more youthful breast. There are times when both a lift and augmentation are needed to achieve desired result.

One area that we do not talk about as much is the nipple areolar complex. The nipple itself can become elongated from nursing and hormone changes, and the areola itself can look larger once the breast has been stretched with pregnancy or weight gain. The areola itself can be reduced in size, as can the nipple. This can be done in combination with either a breast lift or a breast lift with augmentation, and can be performed alone also.

For the tummy tuck portion of the mommy makeover, there are also a couple of different options. The first is a mini tummy tuck that can be performed through a smaller incision like a C-section scar. This can be performed for women who have had C-sections or for women who have not. This is less invasive than a full tummy tuck, but not everyone is a candidate. A full tummy tuck is a longer incision than the mini tummy tuck incision and can incorporate an old C-section scar and revise it. Both of these surgery options can be performed in women with and without C-sections and both involve removing the excess skin on the abdomen. One area of the tummy tuck that most people are not aware of that I commonly do is a diastasis repair. The diastasis is the longitudinal fibrous tissue of the abdomen that separates the “six pack” of the abdominal muscles, and has commonly been spread by the stretching of the abdomen with pregnancy. When women say they cannot get their waist back after pregnancy, this is usually why. The fibrous tissue between the abdominal muscles has been spread out, and no amount of sit-ups will return the fibrous tissue to its original state. With a tummy tuck, I can go in and repair the diastases, essentially cinching the waste back down to give women back their natural hourglass curve.

The mommy makeover is one of our highest satisfaction procedures. To see what type of breast and abdominal surgery combination is right for you, please come in for your complimentary consultation with Dr. Timothy Janiga.

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What is Otoplasty, and Who is a Good Candidate?


Otoplasty is a procedure performed on children and adults who would like to have their ears lay flatter against their head or who would like the shape of the ear changed. Most people believe otoplasty is only a procedure that pins the ear back to the head, or what’s called “ear pinning.” However, by definition it also includes procedures where the shape of the ear is changed. There are many reasons why people want to change the shape of the ear – including genetic abnormalities – but there can also be cosmetic reasons for the procedure.

When people are exposed to new social situations such as starting a new school, entering a new class, starting a new job or entering college, they may be exposed to a new set of people and feel uncomfortable if their ears do not lay flat against the head or if their ears have an abnormal shape. This is especially common in people with short hair and in those who wear their hair in a ponytail for particular activities. It may not have bothered the person when they were younger, but when these situations arise, ear shape or prominence may begin to bother them.

Otoplasty is performed in children to remove the prominence of the ears or to reshape an abnormally shaped ear the child was born with. With children, this procedure usually needs to be done in the operating room. The downtime after surgery is minimal, but anesthesia can make a child tired for about a week after a procedure.

For adults, both ear pinning and ear reshaping can be performed under local anesthesia in the office in most circumstances. The downtime is minimal, but for more involved cases there can be some discomfort for about a week.

If you or your child is having difficulty with the shape
or prominence of the ears, please call 775-398-4602 to make an appointment to see Dr. Timothy Janiga for a consultation.

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Medical tourism: approach plastic surgery abroad with caution


The trend of going out of the country to receive plastic surgery continues to increase. According to Patients Beyond Borders (www.patientsbeyondborders.com) over 1 million United States citizens traveled outside of the United States for medical procedures. The most common procedures are cosmetic dentistry, cardiovascular surgery, joint replacement surgery, fertility procedures, weight loss/lap band, and cosmetic surgery. Some of the most common countries that people travel to receive these surgeries are Costa Rica, India, Malaysia, Mexico, Thailand, Taiwan, and Turkey. The medical tourism industry continues to increase as healthcare costs in the United States increase. Deductibles for insurance are higher so patients are responsible for a larger portion of their medical costs, surgical facilities and hospitals are charging more for overnight stays and medication, visitation fees, nursing care, and postoperative care costs all continue to increase with time.

This discussion is not intended to disparage any other country or international physicians as there are a lot of great hospitals and great physicians locally and internationally, it is intended to educate you regarding the major risks of having procedures outside of the United States from my perspective.

Let us review some of the positives regarding hospitals, surgery centers, and physicians in the United States. Hospitals are regularly monitored by the government bureau called JAHCO. This agency will conduct surprise inspections, monitor infection rates, monitor patient volumes and readmission for complications. The hospitals in the United States must be accredited and certified in order to perform surgeries on patients with health insurance. Surgical centers whether inpatient or outpatient, must undergo similar accreditation by JAHCO and a separate surgical center accreditation to become an insurance certified surgery center. Physicians in the United States are monitored by their individual and respective boards, have to do continuing medical education in order to maintain their board certification, and can be researched on their state medical board website for certifications and disciplinary action. These are all safeguards put in place through the government and state agencies to ensure that the best safety measures and quality are provided to the patients in each state.

Internationally, there has been a movement to use the same American criteria for hospitals and surgery centers as an international standard. Our JAHCO will have its international version called Joint Commission International and the international surgical centers will also have a separate accreditation that should be closely equivalent to American standards. This criteria has been met by some international facilities. Physician certification in other countries varies by country. India and England for example follow a similar structure and certification, while some Asian countries have a completely separate way of certifying physicians as specialists that would perform surgery.

There are some risks outside of accreditations and certifications that patients should also be aware of. First and foremost is having to travel after having surgery. The postoperative recovery period varies for each type of surgery, but can range from a week to three months depending on how involved your surgery. Traveling on an airplane a short period of time after surgery can increase your risk of blood clots in the legs and may predispose you to bleeding or infection at a time while you are traveling and not able to reach a physician quickly. Additionally, postoperative complications are possible for months after your surgery. Most complications occur within the first three months, but it is possible to have new pain, infection, or an issue with an implantable device months to years after that surgeries been performed. If your physician is located outside of the country it will be difficult for you to find postoperative care especially for an immediate complication while you were traveling. Lastly, most health insurance plans now have provisions in their policies that they will not cover any complications from surgery performed outside of the United States. This means if you have a complication such as bleeding, infection, or a problem with an implantable device, any emergency services that you received in the United States afterwards maybe denied through your health insurance policy. Your health insurance wants you to have surgery at a contracted, accredited facility with a board-certified surgeon that has been vetted by your insurance company as an approved and credentialed physician in that specialty.

In conclusion, the motivation for having procedures outside of the United States is usually a financial motivation as it is less expensive in general to have procedures performed in other countries. However, safety is the utmost priority when it comes to your health and this should be your first and foremost consideration when making the choice to have an operation. There is no system that is perfect, including the healthcare system in the United States, but it is no coincidence that important figures from across the world travel here to have their surgeries performed, why would you go somewhere else?


– Dr. Timothy Janiga

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Cosmetic Surgery is on the rise. Will you partake?

Botox Injections

TIME magazine’s June 18 cover story was titled, “Nip. Tuck. Or Else. Why you will be getting cosmetic procedures even if you don’t want them.” After reading this article, I was excited to see some things mentioned, and I disagreed with one major point.

The concepts that I thought were covered well were numerous. The article also did a great job of talking about different types of surgeries and the different types of patients that are getting surgery in the U.S. The general idea that the old concept of hiding your procedures was mostly de-bunked and the new ideas of being proud of your choices were reviewed. The best part of the article, in my opinion, was the outline of the increase in cosmetic procedures. It is true that cosmetic procedures continue to increase every year as new technologies, less invasive procedures and great techniques improve. So, it’s little surprise we’ve seen a rise in procedures.

The one area that was covered extensively in this article that I disagreed with was the idea that plastic surgery is done – and will be done – because people are trying to keep up with their neighbors. In my practice, I do not find this to be true.

In general, most women (and men) come in to my office to improve a particular area that bothers them. The patient may be a mother who would like to get her pre-baby body back with a mommy makeover, a person changing career tracks and wanting to look their best with a facelift, or someone who has always been bothered by a particular area on the body such as the nose. Overall, my patients are everyday people with families and jobs who just want to look their best. These men and women are usually referred by a friend who has had surgery with me, but they do not come in because their neighbor had surgery.

The article in TIME is a good read, full of information, but a few areas should be taken with caution.

If you are considering plastic surgery, do it for you! Call us or go online to schedule a consultation with a board-certified plastic surgeon who can help you decide which procedures are best for you.

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