Dr. Michael A. Kremer - "Passion for Perfection"
Dr. Kremer featured as an expert in renowned business journal "European Business Report"
The questions listed below have been put together by our medical director, Dr. MichaelKremer, MD, from online as well as from personal consultations.
The questions are being updated constantly and are included here to provide you with additional information.
Should you have any questions yourself, please feel free to contact us!
Question:
This is a question to Dr. Michael Kremer: I am a 24-year old male from Dhahran/Saudi Arabia. Even though I accept that a rather large nose with a hump is a typical ethnic feature in arab males in my country, I am convinced that my nose in particular is far to big and too broad. It appears almost African to me. I am very self-conscious about this and would like to consult with you during my next trip to Munich in June. Please, doctor, help me! Thank you, Mohammad
Answer:
Dear Mohammad, thank you for contacting me from long ways. I fully understand your concerns and can assure you that you are not alone: in the past I have treated many male patients from your country and other countries in the gulf area. Even though ethnic features are to be considered particularly in rhinoplasty, some patients simply have to big of a nose and need plastic surgery.
When you come to my office, I will demonstrate to you many before-after pictures of other arab males and you will see, that I did not change their looks but enhance their looks. I set great effort in creating a very natural result so that you see the difference you always wanted but people around you don't realize that you had cosmetic surgery. Together we will - step by step - do a computer simulation in order to determine how much change you want and how this would look. I can assure you that your final result will closely match what we planned ahead of time and that you will not end up like Michael Jackson.
Question:
I am worried that my looks may be changed too much by cosmetic facial surgery and that I will not be myself after surgery. Are my fears justified?
Answer:
The goal of cosmetic facial rejuvenation is not to cause extreme alterations of one's appearance. This may be desired in the case of severe congenital facial deformities. However, age-related changes are desired to be removed by most patients and only characteristics that really annoy patients are really being changed. Ideally, cosmetic facial rejuvenation should result in that a positive change of the patient's appearance is being recognized by the personal surrounding, however, nobody really can tell or dares to ask why this is so.
Answer:
This is a very common question and, unfortunately, there is not a simple answer. Treatment of stretch marks is somewhat a function of where they are located. Some people get stretch marks under the arms, many get them on the abdomen after childbirth and pregnancy, and patients of both sex get them on various parts of the body after a significant weight loss. Sometimes the stretch marks can be eliminated by direct surgical excision of the redundant skin, such as in the case with an abdominoplasty ("tummy-tuck"). Many kinds of body contouring procedures can be done to improve the contour of the area, remove or minimize stretch marks, albeit at the cost of an additional scar from the surgery itself. Most topical preparations for stretch marks are not effective. Laser treatments or injectable treatments from our experience don't seem to improve stretch marks at all.
Answer:
Rhinoplasty can really make a difference in a person's facial appearance. The nose has a very prominent position in the face and most people are quite conscious about that. I would encourage you not to feel you are being vain about your appearance as I frequently see both men and women who are concerned about the appearance of their nose. It is difficult to say what would need to be done in your particular case without examining you. If you have access to a digital camera or a scanner, I would encourage you to email me some pictures of your nose from the front, from the side, and from the bottom with your head tilted back. With those, I could give you a better idea what the procedure would entail as I would have a sense of what type of rhinoplasty I might need to do. Please, consider to stay at least 2 weeks in Germany after surgery, as the healing process needs to be monitored by us closely.
Answer:
We are confronted with concerns like yours on a daily basis. We can assure you that enhancing your looks - not changing - is of utmost concern to us. The perception of facial beauty is different in American surgeons and European surgeons and likewise in their patients. Dr. Michael Kremer has trained in the US for several years and from his experience puts great effort in creating natural looks as - from your long experience - requested by most patients from Europe and the Middle East. We will show you many before-after pictures during your consultation in our office to further reduce your fears.
Answer:
Cosmetic surgery is performed to reshape “normal” structures in order to improve the patient’s appearance. Cosmetic surgery is not covered by health insurance.
Reconstructive surgery is performed on “abnormal” structures of the body caused by congenital defects, developmental abnormalities, trauma, defects following surgical treatment of cancer, or other diseases or difficult wounds. It is often performed to improve function but many of these operations are also done to improve appearances as well. Reconstructive surgery is usually covered by most health insurance plans, although coverage for specific procedures and the amount of coverage for these procedures varies greatly between health plans. Accident insurance policies often cover the treatment costs for "cosmetic" surgery after trauma.
There are several common operations performed in plastic surgery that are increasingly difficult to get covered by insurance plans. Breast reduction is one of these operations. Other procedures, such as surgery to correct congenitally abnormal ears, remove keloids or widened scars, or scar revisions are additional procedures that are difficult at times to get covered by insurance plans.
Please contact your insurance carrier early ahead of time. Our office will assist you in explaining your individual situation to your health or accident insurance, if necessary by a detailed assessment and photo documentation. Eventually, at least a partial coverage agreement can be negotiated.
Answer:
Typically a facelift does not have an impact on a patient's complexion and skin quality. The capillaries that supply the facial skin lie in the dermis, which is not altered during this procedure. If you are considering a facelift and a are concerned about your skin, we would - after a thorough personal consultation and examination - suggest that you see the aesthetician on our team, who might start you on a medically supervised skin care program.
Answer:
The question as to how long silicone implants last is often asked and the answer is unknown. There are many women who have silicone implants that are 30-40 years old but we cannot really say how much longer they are going to last. The implants utilized at that time are not the same as those currently being utilized. We do believe that each year the implant technology improves and the implants we are using now are clearly better than they were 20 or even 10 years ago. The advice we give to our patients who have silicone implants is to get yearly mammograms, which are probably indicated for early cancer detection if the patients are over 40 anyway, in order to detect any pathological changes.
If you seriously consider breast augmentation, we will be happy to go over further details of this rather confusing matter with you during our personal consultation and you will be able to see and feel different kinds of implants.
Answer:
The approach used by us for breast reduction varies and is based mostly on the size of the patient's breasts, the amount desired to be removed as well as the patient's tissue quality. We use several different technique and personally favour periareolar and vertical mammaplasty approaches, designed to decrease the amount of scarring, to maximize blood supply to the nipple and minimize the risk of damaging sensation to the nipple. However, if a large reduction of breast tissue is necessary, an inverted T-scar will remain, that fortunately for most cases hides nicely below the breast fold and is generally accepted by patients for the trade-off.
For your own safety, we require each patient to undergo a mammography before surgery and the removed breast tissue is being sent to pathology to rule out any forms of so far undetected breast cancer. We are cooperating with well respected and well equipped radiology centers and can arrange for the necessary preoperative diagnostics here so that you do not need to undergo these tests in Abu Dhabi.
We look forward to seeing you this summer! Please, arrange to stay around for about 3 weeks after surgery to that we can make sure that the healing process is o.k. before you return to the UAE.
Answer:
What type of tummy tuck you need is very much a function of what is causing your excess abdominal size. Patients who have excess skin and fat may need to have the skin and fat simply excised. If there is underlying weakness of the abdominal wall or separation of the abdominal wall muscles, abdominal wall work would be needed as well. This is particularly common in mothers following giving birth and may be the case in your particular situation as well. The length of the scar is really a function of how much excess skin and fat you have. If there is a great deal of excess tissue, particularly toward the sides of the abdomen, then the scar will need to be quite long. I try to determine the course of the resulting scar with my patients preoperatively as detailed as possible and - if desired - hide the scar within the so called "bikini line".
All body contouring surgery, unfortunately, involves trading scar for improved contour if there is excess skin or fat that needs to be excised.
Answer:
Breast augmentation in a 42-year-old is not an uncommon procedure. As patient's age, their breasts become more ptotic (droopy) and sometimes an additional breast lift needs to be done.
I personally prefer the armpit approach due to my good personal experience with this method while working in the US as this leaves only an almost invisible scar behind. I almost always use saline-filled prostheses that are being placed underneath the pectoralis muscle. Permanent sensation changes of the nipple hardly ever occur with this method.
Answer:
Rhinoplasty can really make a difference in a person's facial appearance. The nose has a very prominent position in the face and most people are quite conscious about that. I would encourage you not to feel you are being vain about your appearance as I frequently see both men and women who are concerned about the appearance of their nose. It is difficult to say what would need to be done in your particular case without examining you. If you have access to a digital camera or a scanner, I would encourage you to email me some pictures of your nose from the front, from the side, and from the bottom with your head tilted back. With those, I could give you a better idea what the procedure would entail as I would have a sense of what type of rhinoplasty I might need to do. This might also save you a trip to Munich. You can also put some regular photographs in the mail.
Answer:
Liposuction is the most common surgical procedure performed by plastic surgeons today. Traditional liposuction is typically performed as an outpatient and is a very safe procedure when small to moderate amounts of fat are removed. A newer type of liposuction, called ultrasonic liposuction, has been developed over the last five to ten years. To date, there is little data to suggest there is any advantage utilizing ultrasonic liposuction over traditional liposuction. Also, this method has several disadvantages and risks like for example the risk of localized skin burns, as the suction cannula tip can get hot.
Endermology is a non-surgical technique involving externally applied massage and suction that may have some benefits for cellulite in some patients. The primary difference between the two procedures is liposuction will give you permanent results and endermology will not. Endermology is a topical treatment that requires maintenance treatments to see results. Patients may or may not get improvement with endermology. It is sometimes necessary to have a second liposuction procedure to make further improvements but maintenance procedures are not needed.
Answer:
Cosmetic surgery is performed to reshape “normal” structures in order to improve the patient’s appearance. Cosmetic surgery is not covered by health insurance.
Reconstructive surgery is performed on “abnormal” structures of the body caused by congenital defects, developmental abnormalities, trauma, defects following surgical treatment of cancer, or other diseases or difficult wounds. It is often performed to improve function but many of these operations are also done to improve appearances as well. Reconstructive surgery is usually covered by most health insurance plans, although coverage for specific procedures and the amount of coverage for these procedures varies greatly between health plans. Accident insurance policies often cover the treatment costs for "cosmetic" surgery after trauma.
There are several common operations performed in plastic surgery that are increasingly difficult to get covered by insurance plans. Breast reduction is one of these operations. Other procedures, such as surgery to correct congenitally abnormal ears, remove keloids or widened scars, or scar revisions are additional procedures that are difficult at times to get covered by insurance plans.
Please contact your insurance carrier early ahead of time. Our office will assist you in explaining your individual situation to your health or accident insurance, if necessary by a detailed assessment and photo documentation. Eventually, at least a partial coverage agreement can be negotiated.
Question:
I am in Germany with the military and wonder if my insurance, Tricare, will cover the costs for breast reduction?
Answer:
As a registered 'Tricare provider' myself, I have treated many Tricare patients in the past that got approved for breast reduction. If you suffer from associated health problems like chronic shoulder/neck pain, posture problems, skin irritation (intertrigo) you may have good chances to get approved. Please, contact your Tricare office first and arrange for an initial consultation with your military base M.D.. Next, you need to come in for a personal consultation with me. I will examine you, take pictures and will send Tricare my evaluation and treatment plan. Approvement usually will take only a few days. If you have any further questions in regard of the required process, please don't hesitate to call my office. My employees will be happy to explain all the necessary details to you.
Question:
A friend has recommended to me a gynecologist, who performs breast augmentation surgery. Also, I have heard about an oral & maxillofacial surgeon in Munich, who does body liposculpturing. I am not sure if I am safe in their hands?
Answer:
Only board-certified plastic surgeons are trained and qualified to perform the procedures you mention. They are legally obliged to having performed the required surgical procedures during their residency training and can deal with eventual complications as well.
Due to the increased demand for cosmetic surgery in our society and due to the deteriorating reimbursement of doctors by the German public health insurance system, many physicians with a different training background than plastic surgery, general practitioners or even doctors without any specialty training try to perform cosmetic surgery. For better public performance "societies" with well-sounding names were founded in the last couple of years, e.g. the "German Society for Cosmetic Medicine" or the "German Academy for Aesthetic Surgery", to name only a few. Any physician can become a member in those associations and thereby display competence in the filed of cosmetic surgery before the public. However, there is no objective quality control, which is different for plastic surgeons that have to officially deliver a catalog of performed procedures to the State Board of Medical Examiners before they become accredited and licensed to practice plastic surgery. Frequently, non-plastic surgeons also have insufficient insurance coverage in case of malpractice, which unfortunately does not become apparent until a claim is filed.
Please feel free to inquire about the professional background of the doctor you consider at the local state medical association ("Aerztekammer").
Answer:
Typically a facelift does not have an impact on a patient's complexion and skin quality. The capillaries that supply the facial skin lie in the dermis, which is not altered during this procedure. If you are considering a facelift and a are concerned about your skin, I would - after a thorough personal consultation and examination - suggest that you see the aesthetician on my team, who might start you on a medically supervised skin care program.
Answer:
The question as to how long silicone implants last is often asked and the answer is unknown. There are many women who have silicone implants that are 30-40 years old but we cannot really say how much longer they are going to last. The implants utilized at that time are not the same as those currently being utilized. I do believe that each year the implant technology improves and the implants we are using now are clearly better than they were 20 or even 10 years ago. The advice I give to my patients who have silicone implants is to get yearly mammograms, which are probably indicated for early cancer detection if the patients are over 40 anyway, in order to detect any pathological changes.
Saline filled silicone implants, which I personally from my professional experience in the US prefer over silicone filled implants, are much easier to monitor and a leak will not result in inadvertent side effects as can be the case with silicone. Also the rate of capsular contraction is significantly lower in saline filled implants.
If you seriously consider breast augmentation, I will be happy to go over further details of this rather confusing matter with you during our personal consultation and you will be able to see and feel different kinds of implants.
Answer:
The approach used for breast reduction varies and is based mostly on the size of the patient's breasts, the amount desired to be removed as well as the patient's tissue quality. I use several different technique and personally favour periareolar and vertical mammaplasty approaches, designed to decrease the amount of scarring, to maximize blood supply to the nipple and minimize the risk of damaging sensation to the nipple. However, if a large reduction of breast tissue is necessary, an inverted T-scar will remain, that fortunately for most cases hides nicely below the breast fold and is generally accepted by patients for the trade-off.
For your own safety, I require each patient to undergo a mammography before surgery and the removed breast tissue is being sent to pathology to rule out any forms of so far undetected breast cancer.
Answer:
What type of tummy tuck you need is very much a function of what is causing your excess abdominal size. Patients who have excess skin and fat may need to have the skin and fat simply excised. If there is underlying weakness of the abdominal wall or separation of the abdominal wall muscles, abdominal wall work would be needed as well. This is particularly common in mothers following giving birth and may be the case in your particular situation as well. The length of the scar is really a function of how much excess skin and fat you have. If there is a great deal of excess tissue, particularly toward the sides of the abdomen, then the scar will need to be quite long. I try to determine the course of the resulting scar with my patients preoperatively as detailed as possible and - if desired - hide the scar within the so called "bikini line".
All body contouring surgery, unfortunately, involves trading scar for improved contour if there is excess skin or fat that needs to be excised.
Answer:
Breast augmentation in a 42-year-old is not an uncommon procedure. As patient's age, their breasts become more ptotic (droopy) and sometimes an additional breast lift needs to be done.
I personally prefer the armpit approach due to my good personal experience with this method while working in the US as this leaves only an almost invisible scar behind. I almost always use saline-filled prostheses that are being placed underneath the pectoralis muscle. Permanent sensation changes of the nipple hardly ever occur with this method.
The information on this web site is only intended as an introduction to this procedure and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result.
The best method of determining your personal options is to schedule a personal consultation with Dr. Kremer. He will be able to answer specific questions related to your situation.
To schedule your personal consultation appointment, please call us at
+49 (0) 89 - 55 27 450
