Orlando Plastic Surgeon Dr. Thomas Fiala

Dr. Thomas Fiala is a pre-eminent plastic surgeon in Orlando, leading a state of the art cosmetic surgery practice as well as a medical spa for non-surgical aesthetics procedures. Dr. Fiala enjoys a high reputation among his patients, and has an exemplary track record of successful procedures at his practice of more than 16 years. He receives patients from Orlando, Altamonte Springs, FL, and nearby areas like Daytona Beach, Merritt Island and Tampa, for both surgical and non-surgical procedures.

Academic Background

Dr. Fiala is one of few doctors in Central Florida who has been board certified by both the American Board of Plastic Surgery and the Royal College of Physicians and Surgeons of Canada. Dr. Fiala completed his residency in plastic surgery from the University of Michigan, with a research fellowship in plastic and microvascular surgery at Harvard’s prestigious Massachusetts General Hospital. He followed this with a fellowship in facial cosmetic surgery with a leading facelift expert, Dr. John Owsley.

Memberships

Dr. Fiala is an active member of some of the leading organizations in the arena of plastic surgery. The most eminent of these organizations include the following:

  • The American Society of Plastic Surgeons
  • The American Society of Aesthetic Plastic Surgeons
  • The Florida Society of Plastic Surgeons
  • The American College of Surgeons

Surgical and Non-surgical Expertise

In addition to running his own plastic surgery practice in Orlando for over 16 years, Dr. Fiala is also the founder and director of Fiala Aesthetics Medical Spa, which provides state of the art non-surgical treatments. Patients in Orlando, Altamonte Springs, FL, and surrounding areas have an opportunity to receive state of the art invasive and non-invasive solutions from him.

Dr. Fiala’s expertise includes the following procedures, among others: Breast augmentation, breast lift, breast reduction, tummy tuck, liposuction, body lift, arm lift, thigh lift, facelift, eyelid lift, forehead lift, facial filler injections, laser resurfacing, photofacial treatments, laser skin tightening, and chemical peels.

Personalized Treatment

Dr. Fiala believes in addressing the aesthetic needs and goals of each patient in a personalized manner, and provides customized solutions designed to meet those specific goals. Right from the initial consultation process, he remains keenly interested and attentive to the patient’s needs, aspirations and expectations, and prepares a treatment plan that is tailored to match those individual requirements. He draws his satisfaction when he is able to bring joy to the lives of his patients through desirable and sustainable outcomes.

RealSelf 100 Award

The highly popular RealSelf online community for doctors and patients has honored Dr. Thomas Fiala with the coveted “RealSelf 100” award. This is an acknowledgement of his dedicated and altruistic efforts to achieve high levels of patient satisfaction through state of the art aesthetic surgical and non-surgical procedures.

For more information of the treatments and procedures offered at this Orlando Medical Spa by Dr. Thomas Fiala please contact us at (407) 339-3222(407) 339-3222 or visit www.plasticsurgeryinflorida.com ; http://coolsculptinginorlando.com/

Very quietly, almost under the radar, Allergan has changed the terms of their saline implant warranty.
It only affects patients who have received saline implants after July 1, 2014.  The changes do not apply to patients who receive gel implants.
Now, under their “standard plan”, they will continue to give lifetime replacement in case of deflation for both sides.  However, there is no more financial assistance for surgery costs.  Zero money to help patients with expenses.  This is the big change.
They have, however, now introduced a new “Premier” level of warranty, which costs $200 to purchase, and the patient must enroll within 45 days of surgery.  With this plan, up to $2400 of financial assistance is available during the term of the warranty.  So this would probably be used up with one operation.
Editor’s note:  While Allergan is certainly within their rights to change their warranty policies, I really dislike how they haven’t brought this to the attention of the plastic surgery community.  No emails, letters, announcements, messages from our rep – nothing.   I found about the changes quite incidentally today (9/16/14), so I am posting this immediately for the information of our upcoming patients.
As yet, there are no implant warranty changes announced by either Mentor or Sientra.
Getting a incision to look fantastic after surgery is a combination of several factors:
   a)  proper placement of the incision
   b)  tidy suture closure, done in multiple layers
   c)  avoidance of tension
   d)  … and a little bit of luck.
Recently, we’ve been using a new product at our office – and I wanted to share the early results with you.  It’s a special dressing, called “Embrace”, made by a start-up company called Neodyne.  Two plastic surgeons, Michael Longacre and Geoff Gurtner, are the brains behind the outfit.  (I know Geoff from surgical residency days.)
The dressing is a stretchy silicone material that is placed across the incision in the stretched position, then attached.  As the dressing retracts, it reduces the tension on the incision.  And when worn for 8 weeks after surgery, this off-loading of the tension not only causes less widening of the scar, it results in less thickening and a better cosmetic appearance.  This has been proven in several studies.
We’ve been recommending this dressing on all of our recent tummy tucks and body lift procedures.  And the early results have been impressive – it really works.  The people who use this product are seeing significant cosmetic improvements.
Here are some photos from the company – these are very similar to the results we are seeing.  The untreated scar is on the left, and the treated scar – from the same patient – is on the right.
The American Society for Aesthetic Plastic Surgery has released its report on plastic surgery in the USA for 2013, based on recent surveys of plastic surgeons, otolaryngologists and dermatologists.
Here are some of the highlights of the report:
  • Over 11 million surgical and non-surgical cosmetic procedures were performed in the US in 2013.   Over 85% of these were non-surgical, such as Botox, fillers or laser treatments.
  • Compared to 2012, there was a 6.5% increase in the total number of cosmetic surgical procedures.
  • The most popular surgeries were:  (#1)  liposuction and (#2) breast augmentation.  These two procedures reversed their order from last year’s report.
  • The most popular non-surgical procedure is: Botox, with over 3.7 million injections performed last year.
  • Buttock augmentation is on the rise, with 11,500 procedures being done this year, compared to only 7,200 the year before.  This procedure wasn’t even on the radar screen just a few years ago.
  • Women accounted for 90% of all surgeries.
  • The most common procedures for men are: (#1) liposuction, (#2) cosmetic eyelid surgery.
More details will be published shortly at the ASAPS website (www.surgery.org)
It gives me great pleasure to announce the 2014 results of Orlando Magazine’s  “Best of Orlando” issue.
(drum roll…)
We have been selected as the best plastic surgery office in Orlando, for the second year in a row.
In this poll, held annually, readers write in, or vote online, for their favorite shops, restaurants and services.  Although there are a few other local newspapers and magazines that have these polls, the Orlando Magazine “best of” is really the grand-daddy of them all, and carries the most prestige.
Congratulations also go to Drs. George Pope and Edward Gross, who got the silver and bronze medals in this category.
I’m very grateful to our patients and friends who took time out to vote for us, making us the top-rated plastic surgery office.  I appreciate your faith and trust in our service, and will continue to work everyday to bring you the best surgical results possible, together with a great patient experience.  That’s our motto – and we take it seriously.
Thanks again for your support!
Dr. Fiala
When you do a lot of a particular surgery, it’s not uncommon to see patients that have had a procedure elsewhere, that come in to see if a previous result can be improved.  Recently, I performed two full “re-do” tummy tucks….which is the topic of this blog.
While there isn’t a formal classification system, I would suggest that patients seeking out a re-do tummy tuck, or “secondary abdominoplasty”, fit into one of four main groups.
These are:
1.   the “under-done” first operation
2.   scar-related issues
3.   recurrent abdominal wall stretch
4.   an unsatisfactory umbilicus
The first group, in my experience, is the most common.  It includes people that had a mini-abdominoplasty when they probably should have had a standard or extended tummy tuck, or patients that didn’t have plication (repair) of the upper abdominal wall muscle fascia when they probably should have.
The second group includes both widened or irregular incisional scars, as well as poorly placed incisions.  It also includes patients that had wound healing complications after their first procedure.
The third group, less common, are patients who despite a good first operation, seem to have poor quality fascia that stretches out sooner than ideal, or bulges in other locations after the midline separation is repaired.
The fourth group have belly-button issues: too big in diameter, too small, heavy scarring, and so on.
The first step in treatment is to find out the patient’s story and do a good physical assessment.  Is the problem primarily one of skin laxity?  Where is this laxity located?  Is it a muscle wall problem?  Or subcutaneous fat?
For patients that had a mini-tummy tuck the first time, we typically see a pattern of upper abdominal looseness or bulging and lateral “dog ears” (excess skin towards the sides of the trunk).  This can often be improved by converting the patient to a standard or extended abdominoplasty, excising the extra skin, and re-doing the muscle repair in both the upper and lower abdomen.  It does mean a longer incision.  Additionally, sometimes there is a small vertical incision in the midline, due to the closure of the umbilical cut-out.  Overall, good results are seen.
For patients with scar issues, standard techniques of scar treatment and revision can be used.  For those where surgery is required, the old scar is excised, and a careful re-closure of the tissues, including scarpa’s fascia, dermis and a tidy subcuticular closure, is performed.  If there is some laxity in the skin above the scar, we can borrow that looseness, to move the scar to a somewhat lower location.
Poor quality “stretchy” fascia is a challenge to deal with.  I’ve seen this problem most often in women that have had 3 or more children, but there are other causes as well.  Repair methods can include re-suturing the fascia, or adding some internal supporting structure, like hernia mesh or dermal matrix – but both of these have associated trade-offs as well.
Finally, and one of the most challenging of all 4 types, is to fix the badly distorted umbilicus.  Our surgical techniques here are limited, and sometimes the results are a compromise.  Large belly buttons can be reduced in size, but may stretch out again, despite internal sutures.  Stenotic, tiny belly buttons can be enlarged with V-Y Plasty techniques – but sometimes will scar down again.  We win some, and lose some.  This is a category where realistic expectations and clear communication between surgeon and patient is especially important.
in summary, this is a diverse group of patients.  Many times, we can offer the patients a nice improvement, and a happy conclusion to their tummy tuck story.
With more emphasis in pop culture on the shape of the derriere, more patients are coming to see us about the idea of buttock augmentation.  One of the most common questions I hear is:  Which is better – the brazilian butt lift or buttock implants?
While both methods can work, for patients that have a reasonable amount of fatty tissue that we can borrow, the brazilian butt lift – also known as fat transfer to the buttock –  clearly wins.  Here’s why:
  • you get the twin benefits of buttock enhancement and the slimming effect of liposuction of the waist, abdomen, thighs or wherever the fat is taken from
  • fat grafting, when performed by experienced plastic surgeons, is a safe procedure and has a lower complication rate than buttock enhancement with solid silicone implants
  • contouring of the buttock is much more flexible with fat grafting.  When a buttock implant is used, there are a limited number of sizes and shapes.  You are also limited about what size of implant can fit in an intra-muscular pocket.
  • Post-op recovery is more painful with buttock implants.
  • Some complications, like migration of the implant, capsular contracture, or wound separation – can only happen when solid buttock implants are used.  They can not happen with the fat injection technique, as the surgical method doesn’t involve making an incision and a large pocket.  Since fat transfer uses your own tissue, there is no risk for capsular contracture.
That being said, there is one group of patients who do better with buttock implants:
  • patients that don’t have enough fat to graft, and can’t or won’t gain weight
Additionally, fat grafting to the buttock does have a downside.  Sometimes that fat that is transferred may not survive the move, and may melt away.  A second fat transfer procedure may be required to optimize the size and shape of the buttock.. But that is usually much easier than the revision of a buttock implant.

The drug anastrozole cuts breast cancer incidence in half among high-risk post-menopausal women, according to an study just published in the Lancet.

Anastrozole, also known as “Arimidex”, is a type of drug known as an aromatase inhibitor.  It works by reducing the production of estrogen, like its better-known cousin, Tamoxifen.

In the study, nearly 4000 post-menopausal women at increased risk for breast cancer were randomized to receive daily anastrozole or placebo for 5 years. During the 5 years of average follow-up time, breast cancer developed 53% less often among anastrozole recipients (2% vs. 4%). The researchers estimate that 36 women would need to receive Arimidex to prevent one cancer during a 7-year period.

The researchers say their results “strongly support” anastrozole for preventing breast cancer in high-risk women. The once- daily pill is relatively inexpensive, since the patent has expired. And it works better than tamoxifen in this group.

 Now, if they could only come up with something for pre-menopausal high risk women….
In this month’s issue of Plastic & Reconstructive Surgery, is a study that will be of interest to all who follow breast augmentation.  It’s a 5 year analysis of capsular contracture rates using Sientra implants for first-time breast augmentation, and a look at some of the factors that influenced capsule formation in 2560 first-time breast augmentation patients.  A variety of surgical methods – subglandular, submuscular, different incisions, and other factors were reviewed.
The investigators found that, in looking at the group as a whole:
–  subglandular placement of implants increased the risk of a capsule by 4.6 times
–  use of  periareolar incisions had more contractures than inframammary incisions by 1.5 times
–  Sientra smooth implants had 4.7 times more contractures than Sientra textured implants overall.
These findings have been noted in previous implant studies, so they were not any big surprise to me.  They confirm my decisions to switch away from the periareolar incision, and stay with the submuscular dual-plane placement method.
To me, the most interesting part of this article was the grouping of capsule formation rates by technique:
smooth implant in a subglandular pocket 21% capsule rate
smooth implant in a submuscular pocket 5% capsule rate
textured implant in a subglandular pocket 5% capsule rate
textured implant in a submuscular pocket 2% capsule rate
Since I currently do my breast augmentation operations with a submuscular pocket, this data suggests that if I were to use Sientra textured implants, I could reduce my capsule rate to 2%, from its current rate of 4% with smooth gel implants.  That’s a pretty convincing argument to recommend these implants.  Based on 200 augmentations a year, for example, I could potentially prevent 4 women from having issues with capsules each year, just by choosing a different implant.  And that, to me, is well  worth considering.

How often do you hear about “no recovery” or “lunchtime” treatments when reading about lasers, peels and other treatments in the media?  Until recently, there was no accepted definition for these terms. What does “minimal recovery” really mean – minimal to whom, the doctor, or to you?

The American Society for Aesthetic Plastic Surgery (ASAPS) has developed a set of standardized definitions that consumers and industry can use, when talking about issues like downtime, bruising, redness, swelling and pain.  We’re trying to encourage the cosmetic laser industry to adopt and use these terms in a consistent and honest way, so that consumers can really fully understand what they’re choosing, and can compare treatments while shopping around.

DEFINITIONS OF TERMS

Downtime –the expected time to return to normal lifestyle

Essentially None: less than 24 hours

Minimal: 24-72 hours

Moderate: 3-7 days

Significant: more than 7 days

 

Bruising – visible on the skin without concealer

Essentially None: no bruising but there may be an immediate change in skin tone

Minimal: less than one week

Moderate: 1-2 weeks

Significant: more than 2 weeks

 

Redness –visible without concealer

Essentially None: returns to normal (pretreatment or improved) in less than 24 hours

Minimal: 1-3 days

Moderate: 4-7 days

Significant: more than 7 days

 

Swelling –obvious swelling

Essentially None: less than 3 days

Minimal: 3-7 days

Moderate: 8-14 days

Significant: > 14 days

 

Pain –significant discomfort associated with the treatment

Essentially None: no anesthesia or medication is needed except over the                                      counter  medication

Minimal: requires pretreatment with oral prescription medication, topical anesthetic agents                or skin cooling and/or post-treatment prescriptions for pain management.

Moderate: same as minimal but with local anesthesia (injections)

Significant: same as minimal but with IV sedation or general anesthesia

RealSelf
Plastic Surgery In Florida