I had the pleasure to sit down with Dr. Bryan Forley, a Manhattan based Plastic & Reconstructive Surgeon. Dr. Forley is one of the few plastic surgeons who tells his patients what will and won’t work for them. He doesn’t look at a patient from a financial perspective but truly as a model who wants to be perfected by an artist. His passion is evident when he speaks about his work, and how he strives to be a perfectionist. His clients are word-of-mouth referrals and that is what he takes great pride in. I’m grateful Dr. Forley found time to share his insight on the latest and greatest treatments available.
SL: Winter elements can be very harsh on the skin. What is the biggest complaint that your patients have?
Dr. Forley:Winter and the beginning of a new Year are often a time for reckoning when the desire to improve oneself reaches its peak. This is the time when people are ready to tackle the aging changes that have been simmering for years or prepare for the inevitable shift to outdoor activities in warmer weather. This time of year is a time when many concerns are addressed. I have the opportunity to perform a wide range of non-surgical and surgical procedures.
SL: I know that both men and ladies worry about sun damage and wrinkles, particularly to the face. What non-invasive procedure would you recommend to your patients?
Dr. Forley:Preventing sun damage and wrinkles is my best recommendation. The most common way to prevent premature aging from excessive sun exposure is to use sunscreen regularly on your neck and face. décolletage, hands, and body. Regular use moisturizers will help keep the skin hydrated. This will make it less likely to develop damaging free radicals from environmental pollutants and UV radiation.
SL. We are big fans of Evoke. We know that you are one among the few surgeons who use this treatment. Please tell us how it works.
Dr. Forley:Evoke offers a non-invasive alternative to surgery that can yield meaningful results for selected patients. The technology works by delivering radiofrequency energy below the skin to improve contours of the jawline or neck. This is done without any downtime and pain. The electrodes are held in place by a special treatment mask for each area for 45 minutes. This results in a bulk heating effect. After 3-6 treatments, visible improvements can be observed that look very natural and complement other non-surgical aesthetic procedures. Although the results may take a while to see, maintenance treatments can be done between 12-18 months.
SL: Let’s talk about cellulite as I know that is a problem area for many people. What are your options for these patients?
Dr. Forley:Cellulite, a common problem, is most prevalent in women over the age of 30. Cellulite is caused by fat distribution, fibrous bands running from the fat to skin surface, and hormones. There are many treatments available, from creams to energy devices to injections. All of them have mixed results. It is often a sign that not all solutions work well when there are many options. In an effort to combat cellulite, we have recently begun to use the Morpheus8 Body device. It tightens skin, remodels fat, and breaks down fibrous bands. This technology uses radiofrequency energy to deliver radiofrequency energy through an applicator that has multiple microneedles. The depth of penetration can be customized to reach different depths below skin surface. When a patient is considered a candidate for this innovative treatment for cellulite, a series 4-6 monthly sessions is recommended. In most cases, maintenance treatments will be required every 12-24 month.
SL: Breast implants. Are you in favor or against breast implants? Any long-term side effects? Can cancer still be detected in the same way as a woman who is healthy?
Dr. Forley:Silicone gel breast implants or saline-filled breast implants can be customized to address a variety of issues such as size, sagging and asymmetry, as well as reconstruction.
Although breast size is the primary reason for breast implant surgery, improving self-esteem and confidence can be equally important for older patients as well.
Breasts can look sagging and deflated after pregnancy. This, along with changes in the appearance and body image after childbirth, can cause problems. These two problem areas are often treated by what is commonly called a “mommy makeover” in which a tummy tuck is combined with implants to replace the missing volume of the breasts. A breast lift may be required in certain cases. However, implants with higher profile can often give enough projection to lift breasts without adding scarring.
Asymmetry in the breasts can lead to a variety of psychological issues that can have a negative impact on the growth and development of the patient. A solution to this problem is possible by compensating for the difference in breast size using implants with different volumes and dimensions. Sometimes, it may be necessary to reduce the breast size or increase the breast size with an implant.
The combination of tissue expanders, implants and tissue expanders can help to reconstruct breasts after treatment for breast cancer. This is also known as immediate reconstruction.
Implants pose long-term risks. These include implant deflation, capsular contraction or hardening breasts, surface rippling, irregularities, and hardening of the breasts. These and other rare risks are discussed with your surgeon during your initial consultation. Breast implants can be used to detect breast cancer using common diagnostic tools.
SL: Is there a specific age when a person should start with non-invasive treatments meaning is it safer at a later age opposed to somebody in their 20’s?
Dr. Forley: There are a variety of non-invasive or minimally invasive treatments that offer beneficial outcomes to the aesthetic appearance of the face and body irrespective of a patient’s age. Patient satisfaction is best achieved when there is a realistic expectation of improvement. This is true regardless of the treatment used. Safety is more about matching the correct procedure to the patient’s needs, rather than arbitrarily linking the procedure to their chronological years.
SL: Please share any other treatments that you have used and recommend to your patients. This will help us identify the best candidate for each.
Dr. Forley:Both men and women are concerned about the impact that their lower eyelids have on how they see themselves and how others perceive them. Baggy lower lids are associated with an aged, tired appearance. This is due to prominent fat pads on the lower eyelid, wrinkled, or poorly elastic skin, as well as the visible tear trough, which is a visible area under the eye. We have many options to address this issue. Injectable filler can be used to smoothen the transition between the eyelid and the cheek. This will help to improve this early sign of aging. 
In more advanced stages of the baggy lower eyelid, a fat transposition lower lid lift or blepharoplasty is performed. This procedure is performed through an incision made on the inside of your lower eyelid to leave no visible scarring. The first step involves releasing the tight band that caused the tear trough depression. After excess fat has been removed from the lower eyelid, the existing fat pads are moved or transposed into the lid-cheek junction.
This results in a brighter and more youthful appearance to the eye that looks natural and non-surgical. Lasers or radiofrequency treatments can often be used to address skin wrinkles, elasticity and wrinkles.
SL: It was a pleasure to speak with you as always and we look forward interviewing you again in the spring.
DR: Forley: It was a pleasure to speak with you.
Bryan G. Forley, M. D., F.A.C.S.
5 East 82ndStreet
New York, NY 10028
Plastic & Reconstructive Surgery
212.861.3757
www.drforley.com
