James D. Namnoum, M.D., F.A.C.S.
Board Certified in Plastic & Reconstructive Surgery
Co-Director of the internationally acclaimed Atlanta Breast Symposium
Chief of Plastic Surgery, St. Joseph's Hospital
Cosmetic Surgery
Cosmetic and plastic surgery is a surgical specialty to enhance and correct the face and body aesthetically. Dr. Jim Namnoum has a special interest in breast augmentation, management of implant-related complications including synmastia and malposition, mastopexy using short, cosmetically hidden scars. He has wide experience in body contouring, including abdominoplasty, trunk lift, buttock enhancement with fat transfer, buttock lift, and liposuction. He utilizes the latest innovative techniques in facial aesthetic surgery, including endoscopic brow lift, midface rejuvenation, face and neck lift, and TCA skin peelsspecialized surgical training allows him to produce exceptional, natural-looking results for his cosmetic surgery patients.
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Plastic & Reconstructive Surgery Technology
As a leader in the field, Dr. Namnoum’s reputation and commitment to advancements in plastic and reconstructive surgery has allowed him the opportunity to trial many of the industry’s newest technology for all areas of the body and face. Because Dr. Namnoum is among the first in the nation to have access to these advancements, his patients are also among the first to have access to the cutting edge technology designed to enhance overall patient experience.
Breast Enhancement / Augmentation
Having completed his fellowship in breast surgery with surgical pioneer and founder of Atlanta Plastic Surgery Carl Hartrampf, M.D., Dr. James Namnoum has honed his skills to become world renowned in cosmetic and reconstructive surgery of the breasts. His mastery of breast reconstruction techniques allows him to produce exceptional, natural looking results in cosmetic surgery of the breasts as well.
Breast enhancement, one of the most popular cosmetic procedures today, involves the surgical insertion of a saline or silicone implant to augment the shape and size of the breasts. Dr. Namnoum uses the most up-to-date, minimally invasive techniques to achieve each individual patient’s desired look.
As with all his patients, Dr. Namnoum makes certain that his breast enhancement patients are as comfortable and as informed as possible about their surgery. That is why he gives the option of viewing detailed procedural videos in consultations, to engage the patient and give them an idea of what the surgery will entail.
Types of Breast Implants
There are two basic types of implants: saline and silicone – the pros and cons of which have been a popular topic of discussion over the years. The saline implant consists of a silicone elastomer shell filled with a sterilized saline solution. Because the implants are filled with a saline solution, in the unlikely event that there is an implant leak or burst, it would cause less harm to the patient than a silicone leakage. The silicone implants consist of the same silicone shell, but the implant itself is filled with silicone gel. Silicone implants are generally more natural looking and feeling than the saline counterpart.
Breast Implant Sizing
While most people tend to think of breast size in terms of cups sizes, A, B, C, D etc., when it comes to breast implants the size is measured by the amount of volume the implant shell holds. Different volume amounts or cubic centimeters (cc) of solution will be recommended depending on the patient’s body type and desired shape and size. Many factors, including a patient’s height, their current breast size, the width of their shoulders, their weight, and body shape, can make the same size implant look very different from one person to another. Dr. Namnoum will work with each patient to determine which size implant will best complement their body frame.
Areas of Incision for Breast Enhancement Surgery
Depending on the patient’s needs and preferences, different incision sites may be recommended in the insertion of a saline or silicone breast implant.
Crease (inframammary) Breast Incision
The most common incision site is called the inframammary incision, or an incision made in the crease under the breast. Making an incision so close to the breast itself allows for the surgeon to have greater control over implant placement and subsequent symmetry. This technique also allows for the implant to be placed under or over the chest muscle. While a scar will result from this type of incision, a well skilled surgeon such as Dr. Namnoum can place the incision in the natural crease of the breast, so that it is only visible when a patient is lying down. An inframammary incision can also be used again if a surgeon needs to perform any sort of breast revision in the future.
Nipple (Areola) Breast Incision
Also known as the peri-areolar technique, the insertion of an implant through the nipple requires a tiny incision on the edge of the areola. Dr. Namnoum makes a tiny incision on the rim of the areola (dark area around the nipple) where the darker skin meets the lighter skin to better conceal the subsequent scar. During this procedure, a protective sleeve is placed over the milk duct to protect interference during insertion of the implant. Like the inframammary approach, the areola incision is made close to the breast, giving the surgeon more control over the implants’ placement. This type of incision is recommended for patients who opt for a breast enhancement in conjunction with a breast lift; because a breast lift procedure requires the same nipple incision site.
Naval (T.U.B.A.) Breast Incision
A breast enhancement with an incision through the naval, also known as the trans-umbilical breast augmentation or T.U.B.A. has the saline or silicone implant inserted though a small incision along the rim of the naval. The implants are inserted unfilled, and then placed into position in the breast pocket. Dr. Namnoum then uses an endoscope and small tube to fill the implant with a sterilized saline solution. This type of approach leaves tiny, unnoticeable scars and has very little risk for breast feeding complications. However, only saline implants can be used with this approach.
Armpit (Transaxillary) Breast Incision
This type of incision for breast enhancement surgery is made in the underarm of the patient. Like the T.U.B.A, unfilled silicone shells are placed into position and then endoscopically filled with a saline solution. Also like the naval incision, silicone implants are not possible with this approach. A benefit of the armpit breast incision is that all scarring is very inconspicuous – even if the scars do not heal properly, they will still be concealed in the armpit. If future breast revisions are needed however, the original incision site cannot be used and the surgeon will have to make an additional incision.
Breast Lift
Dr. Namnoum will recommend breast lift surgery, also known as a mastopexy, for women whose breasts have shifted downward in position due to the effects of pregnancy, age, heredity, and/or weight loss. These factors result in sagging breasts, stretching of the skin, and loss of breast volume. During a breast lift procedure, Dr. Namnoum tightens the supporting breast tissue and trims the excess skin around the breasts to give the breasts a more youthful and upward position. Because of Dr. Namnoum’s expertise in breast surgery, he can utilize techniques to avoid the commonly used “anchor shaped” incision – minimizing the amount of scarring as a result of the breast lift surgery.
Breast Revision
Several different factors may lead a woman who has undergone a breast enhancement surgery to come in for a breast revision. Whether a woman is unhappy with the results received at another physician or there has been a change in the implant over time, Dr. Namnoum can revise your breast procedure in the most minimally invasive way possible. Although rare, it is important to understand the types of complications that can occur. Dr. Namnoum will spend time with each patient to go over any concerns, and measures he and the patient take to try to prevent them.
Capsule Contracture
A capsule contracture is the most common complication arising from a breast enhancement surgery. It is composed of a fibrous tissue lining that your body forms around the breast area in response to a foreign object being placed in the body. While this natural response occurs in all breast augmentation patients, in some cases, the capsule will contract and tighten – tightening the implant itself. This causes the implant to look and feel hard due to the build-up of fibrous tissue. There are four grades of capsule contracture, ranging from Baker Grade I to Baker Grade VI. If this complication occurs, a breast revision surgery, called a capsulectomy, may be recommended in order to remove the capsule and restore a softer look and feel to the breasts.
Bottoming Out
Bottoming out refers to breast implants that have fallen too low – making the nipple too high on the breast and resulting in an overall droopy look. This type of complication is more common with patients who opt for an implant over their chest muscle or in patients who do not have a lot of breast and skin tissue available to support the implant. To correct this complication, scar tissue must be repositioned under the breast to create a new crease and a higher breast position. Traditional breast lift surgery may also be needed to bring the nipple and breast back to its proper position.
Implant Rupture (Deflation)
In rare cases, an implant can rupture or leak. This can be caused by several things such as capsule contracture, injury or trauma, or wear and tear on the implant and can occur any time after surgery. Most ruptures are silent, meaning an MRI is needed to diagnose the problem. Other ruptures can by symptomatic causing pain, swelling, and or lumps. Regular MRI’s are recommended every couple of years in order to diagnose any silent ruptures.
Breast Revisions for Cosmetic Reasons
Sometimes a woman will be unhappy with a breast augmentation received at another physician. In these cases, Dr. Namnoum will work with the patient to understand and redefine their desired look and then develop a plan of action. Dr. Namnoum also performs breast revisions on patients who wish for a bigger, smaller, or different type implant.
Breast Reduction
Breast reduction surgery is recommended for women who have been negatively affected by the size of their larger breasts. Whether they are self conscious about their breast size, would like to fit in a wider variety of clothing, or if they are suffering from health issues as a result of their breast size, breast reduction surgery can reduce the size of a woman’s breasts for a more proportional and realistic size.
During the procedure, Dr. Namnoum will remove excess fat, glandular tissue, and skin from the breasts, making them lighter, smaller, and more firm. Women with larger breasts usually experience sagging of the breasts, therefore a breast lift may be recommended, and stretching of the areola, therefore an areolar reduction may be recommended.
Male Breast Reduction (Gynecomastia)
Breast reduction surgery is a common procedure for males who suffer from gynecomastia, a condition marked by enlarged male breasts due to excess fat and glandular tissue. In the correction of this problem, male breast reduction will be recommended. Dr. Namnoum will remove any unwanted breast fat and then tighten the surrounding tissue. Occasionally an areola reduction will be done in conjunction with a male breast reduction.
Areola Reduction
Usually in conjunction with a breast reduction or breast lift procedure, an areola reduction is needed to correct the stretched look of the areola (dark area of skin surrounding the nipple). Patients who seek corrective surgery on their nipple area are often unsatisfied with an areola that is too large, of unusual shape, or one that protrudes out. Because of Dr. Namnoum’s extensive experience in breast reconstruction (including reconstruction of the areola), he can effectively reshape and contour the look of a nipple during various cosmetic procedures.
Buttock Augmentation/ Buttock Implants
Many women today are choosing to enhance the shape and size of their buttocks for cosmetic reasons. For this type of request there are two options: Buttock Augmentation and Buttock Implants. In a Buttock Augmentation, Dr. Namnoum will liposuction excess fat from other parts of the body, purifies the fat, and then re-injects the fat into the buttocks. This type of procedure has a low risk of infection and can effectively reshape the look of the backside. Buttock implants on the other hand, involve the surgical insertion of a silicone implant into a patient’s backside. Depending on the wishes of the patient, various size and shape implants may be used. However, buttock implants may only be used to contour the top part of the buttocks; to reshape the lower part of the buttocks, fat transfers would need to be used.
Liposuction (Breakdown of Different Types)
Liposuction is one of the most effective tools for contouring the body and enhancing its overall shape. Liposuction involves the surgical removal of excess fat and can be performed in various places of the body – including the tummy, hips, arms, legs, neck/chin, back etc. Each patient considering liposuction or body sculpting has different “problem areas” or stubborn areas of fat that are resisting the efforts of diet and exercise. Liposuction can be the solution to get rid of these problem areas – however it is not a “cure all” solution to a thinner physique. It is important to practice healthy eating habits and regular exercise in addition to liposuction surgery. Read below for an overview of the different types of liposuction techniques:
Tumescent Liposuction
For this type of liposuction, an injection of a mixture of saline solution, anesthesia known as lidocaine, and adrenaline is injected into the problem areas. This helps to numb the area, shrink the blood capillaries to prevent blood loss, and to more easily remove the excess fat. After the injection, Dr. Namnoum goes in with a tube to suction the fat out of the body, using various methods depending on the patient and the area to be treated.
Superwet Liposuction
The superwet liposuction technique is similar to the tumescent liposuction approach except a smaller amount of solution (composed of salt water, lidocaine, and adrenaline) is injected into the body. Superwet Liposuction can be preferred to tumescent liposuction because it takes a shorter amount of time for the solution to take effect – however the tumescent approach will result in the least amount of blood loss.
Ultrasound-Assisted Liposuction (UAL)
After the solution has been injected into the treated areas, using either the tumescent or superwet technique, the surgeon must insert a tube in order to suction out or remove the excess fat. In the ultrasound-assisted approach, the special tube inserted emits ultrasonic energy that breaks down the walls of the fat cells and ultimately liquefies the fat, making it easier for removal.
Suction-Assisted Liposuction (SAL)
Like the Ultrasound-Assisted Liposuction Method, a tiny incision is made and a small tube (called a cannula) is inserted into the problem area. Instead of ultrasonic energy, in the SAL method, the tube is moved back and forth under the skin to break up the fat layers – making them easier to remove. The excess fat then suctioned out of the body.
Noninvasive Liposuction Methods
Lately there has been a surge of discussion about newer types of liposuction such as laser liposuction and lipodissolve that claim to get rid of excess fat in a noninvasive way. However, because these types of liposuction are new to the market, more testing must be done to check the validity of their claims. Traditional liposuction (using the methods described above) are still the most effective way of eliminating excess fat and contouring areas of the body.
Facelift
For patients who wish to refresh the youthfulness of their entire face, often a full facelift is recommended. Using a minimally invasive, short-scar method, Dr. Namnoum can remove excess face and skin and tighten the muscles in the face for a smoother, more youthful look. If a patient wants to concentrate on certain areas of the face, partial facelifts, including a mid facelift for the area between the eyes and mouth, an upper facelift for the eyes and brow, and a lower facelift for the mouth and jowls, can be the solution. Whatever type of facelift procedure you opt for, Dr. Namnoum will ensure that your results are subtle and natural.
Tummy Tuck (Abdominoplasty)
Tummy Tuck Surgery, also known as an abdominoplasty, is a surgical procedure to shape and trim the tummy and waist, and flatten the overall look of the tummy. Dr. Namnoum makes an incision very low on the abdomen, then removes excess skin and fat and tightens the underlying abdominal muscles. The incision will result in scarring between the hips, but is made low enough to be concealed by a patient’s underwear and bathing suit. Whether a person opts for tummy tuck surgery to correct loose skin after significant weight loss or to help shape areas of fat that have not responded well to the efforts of diet and exercise, tummy tuck surgery can be the solution.
Mini Tummy Tuck (Partial Abdominoplasty)
For patients who do not have enough excess skin and fat for a traditional, full tummy tuck, a mini tummy tuck or partial abdominoplasty may be recommended. In a mini tummy tuck, Dr. Namnoum makes a smaller incision and only lifts the skin as high as the naval.
Mommy Makeover
Mommy makeover surgery can be described post-maternity breast and body reshaping. When the effects of pregnancy have caused a women to lose the body she once had, various surgical techniques can be used to lift and reshape. For breasts that have begun to sag and droop, a breast lift or breast enhancement using implants may be recommended. Breast reduction surgery (in conjunction with a breast lift) is often the answer for woman whose breasts have become too large from the effects of pregnancy and breast feeding. The effects of pregnancy usually cause women to gain weight; many have excess skin from the stretching of their bellies – thus for a mommy makeover, a tummy tuck may be recommended to flatten the abdominal area. Liposuction is also used in mommy makeovers to re-sculpt and contour areas of the body that have accumulated pockets of stubborn fat. In a mommy makeover, the goal is for a woman to reclaim the look of her body before the effects of pregnancy. Depending on the individual patient, any combination of these procedures may be included in the recommended treatment plan.
Arm Lift (Brachioplasty)
One of the most common areas to accumulate excess skin after weight loss or the effects of aging is on the upper arms. The skin becomes loose and flabby and does not respond well to weight training. Dr. Namnoum may recommend an arm lift, also known as brachioplasty, to remove that excess skin and fat using targeted liposuction.
Body Lift (Post Bariatric Surgery)
When a person decides to make a life change and either lose a significant amount of weight or undergo bariatric (weight loss) surgery, they are making an important step in the right direction of looking and feeling great. However, often the substantial drop in weight will cause a person to have loose, excess skin on their body – especially around the torso, arms, and legs. Post-Bariatric Surgery, also referred to as a body lift, is used to lift and remove excess skin and tighten the underlying muscles to give the body a trimmer, tighter look. A body lift can include lifts and/or liposuction on any combination of the tummy, arms, back, buttocks, hips, and thighs in order to give the patient a tighter, more proportionate look.
Eyelid Surgery/ Blepharoplasty
When a man or women gets older, one of the first places to show signs of aging is around the eyes and eyelids. For many patients, the solution is eyelid surgery, otherwise known as Blepharoplasty. The procedure involves the surgical removal of excess fat and skin, with specialized techniques for both the upper and lower eyelids. Dr. Namnoum’s years of experience in cosmetic facial procedures, allows him to make minimal incisions while achieving natural looking results.
Chemical Peel
Chemical peels, often recommended after a surgical facial procedure, are effective in removing the outer layer of the skin to reveal healthy skin cells underneath. Also recommended for nonsurgical patients, chemical peels even skin tone and texture – providing skin with a fresh, natural glow.
Laser Resurfacing
When a person has moderate to severe skin damage from aging or years of sun exposure, laser resurfacing may be recommended. During the laser resurfacing procedure, an intense beam of laser light targets and removes damaged tissue, leaving healthy tissue intact. Laser resurfacing may be recommended to correct wrinkles and scarring or to even skin tone after a surgical procedure of the face.
Cosmetic Fillers (Juvéderm®)
Dr. Burstein offers Juvéderm®, an injectable non-animal gel that rehydrates the skin and restores it to its natural volume. The product works by filling in the depressions that develop as aging skin looses elasticity and facial fat begins to lessen. Juvéderm® injections take only 15 minutes, produce immediate results that last up to six months, and require minimal down time. To add to the minimally invasive nature of the procedure, Juvéderm® is now FDA approved for use with the local anesthetic lidocaine to increase patient comfort during the procedure.
Cosmetic Injectables (Botox®)
Botox® Cosmetic is a physician-administered treatment that relaxes the muscles that cause moderate to severe frown lines between the brows and around the eyes. FDA approved for use in men and women between the ages of 18 and 65, the 10 minute procedure consists of a few tiny injections, and produces immediately noticeable improvement which can last up to 4 months.
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