Orange County Plastic Surgery

10/26/2026

Over or Under
By Dr. Deborah Ekstrom
Orange County Plastic Surgery, Corona del Mar/Newport Beach

One of the most common questions I hear during breast augmentation consultations is, "Dr. Ekstrom, should my implants go over or under the muscle?"
Some patients arrive having already consulted “Dr. Google or Dr. ChatGPT” and have decided exactly where they want their implants placed. While I encourage patients to educate themselves, the answer is not always that simple!
Traditionally, plastic surgeons have favored placing breast implants partially beneath the pectoralis major muscle, particularly in thinner patients. This technique, commonly called dual-plane placement, provides additional tissue coverage over the upper portion of the implant.
Below the Muscle — Advantages and Disadvantages
The additional muscle coverage can make implant edges less visible or palpable, particularly in women with very little natural breast tissue. Historically, studies have also associated submuscular placement with lower rates of capsular contracture, the formation of an abnormally tight scar capsule around an implant.
However, placing implants beneath the muscle involves lifting and releasing portions of the pectoralis muscle. This generally produces more postoperative discomfort and can prolong early recovery. Another potential disadvantage is animation deformity, where implants visibly move or change shape when the chest muscles contract.
Above the Muscle — Advantages and Disadvantages
With subglandular placement, implants rest behind the breast tissue but in front of the pectoral muscle. Surgery generally involves less muscle disruption, with less discomfort and often a quicker recovery. The implants also avoid animation deformity.
The disadvantages? In thin patients, implant edges may be more noticeable, and rippling or palpability may become an issue. Historically, subglandular placement has also been associated with higher capsular contracture rates.
What About Capsular Contracture Rates?
Older studies have reported contracture rates ranging from single digits to over 15%, depending on implant placement, surface, surgical technique, and length of follow-up. Some studies have found substantially higher rates above the muscle, but these figures cannot reliably predict an individual patient's outcome. Modern implants and improved surgical techniques have changed the equation, and there is no single percentage that applies to every patient.
A Changing Trend
Increasingly, surgeons are reconsidering above-muscle placement for appropriately selected patients. Another option, subfascial placement, positions the implant beneath the thin fascia covering the muscle without disturbing the muscle itself.
My philosophy? There is no universally superior implant pocket. Breast tissue thickness, skin quality, implant size, lifestyle, previous surgery, and individual expectations all matter.
After more than four decades in plastic surgery, I have learned that the best operation is not necessarily the newest or most fashionable technique. It is the one that best fits the individual patient!

10/19/2026

Know your risk and prioritize your health 🩷

Did you know that several factors can affect your risk of developing breast cancer? Our very own Dr. Bunkis and Dr. Ekstrom discuss these influences as well as the importance of early detection.

Your health deserves attention. Don’t wait to start the conversation! 🌸💌

10/15/2026

For the month of October, we are encouraging proactive care and honoring everyone whose lives have been impacted by breast cancer 🩷🎀

Awareness starts with a conversation. Early detection, routine screenings, and knowing your risk can make a meaningful difference! 💌

10/12/2026

WHEN A LITTLE MEANS A LOT
By Dr. Deborah Ekstrom
Orange County Plastic Surgery, Corona del Mar/Newport Beach

In plastic surgery, we often celebrate dramatic transformations. We have all seen those remarkable before-and-after photographs of patients who have undergone facelifts, tummy tucks, breast surgery, or rhinoplasty. The changes can be extraordinary, sometimes making a person look almost unrecognizable.
But today, I would like to discuss something quite different: how the smallest change can sometimes make the biggest difference in someone's life.
Consider a patient who has spent years feeling self-conscious about a tiny bump on the bridge of her nose. To her friends and family, it may be barely noticeable. But every time she looks in the mirror or sees a photograph of herself in profile, that little bump is all she sees.
A carefully performed rhinoplasty that removes just a few millimeters of bone and cartilage can make an enormous difference in how she feels about herself. Her friends may simply comment that she looks wonderful, without ever realizing she had surgery!
Or consider a patient with a slightly recessed chin. A small chin implant, sometimes adding only a few millimeters of projection, can dramatically improve the balance between the nose, lips, and chin. The result is not necessarily a different-looking face, but a more harmonious one.
The same principle applies to nonsurgical treatments. A conservative amount of hyaluronic acid filler can subtly enhance thin lips, restore lost volume in the cheeks, or soften a bothersome facial groove. The goal is not to create an exaggerated appearance, but to restore balance while preserving the patient's natural features.
Even a small upper eyelid correction can make someone appear more rested and refreshed. A minor adjustment to an earlobe or a subtle refinement of the nasal tip can eliminate a feature that has bothered someone for decades.
Of course, not every perceived imperfection needs correction. The first step is always listening carefully, understanding the patient's expectations, and determining whether a procedure is appropriate, safe, and likely to achieve a natural result.
What makes these procedures so rewarding is often the psychological benefit. Patients may tell us they feel more comfortable having their photograph taken, wearing their hair differently, or simply looking in the mirror. Not everyone experiences the same emotional benefit, but for appropriately selected patients, the improvement can be meaningful.
As surgeons, we take great satisfaction in dramatic transformations. Yet some of our most gratifying moments come when a patient smiles and says, "It's such a small change, but it means the world to me."
Sometimes the best plastic surgery is the surgery nobody notices—but the patient appreciates every single day. https://orangecountyplasticsurgery.com/when-little-things-make-a-big-difference/

10/09/2026

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10/05/2026

RESTORING A MORE MASCULINE CHEST
By Dr. Deborah Ekstrom
Orange County Plastic Surgery, Corona del Mar/Newport Beach

Gynecomastia—the development of an enlarged male breast—is one of the more common procedures I perform, and it is also one of the operations that can make an enormous difference in how a man feels about his body.
The condition may consist predominantly of excess fat, firm glandular breast tissue, excess skin or, quite commonly, a combination. Many cases are idiopathic, meaning that we never identify one specific cause. Hormonal changes, certain medications and anabolic steroid use can contribute. Ma*****na has also long been associated with gynecomastia, although the scientific evidence has not established a definite cause-and-effect relationship.
The important point is that true glandular gynecomastia generally cannot simply be “worked off” at the gym.
Treatment therefore has to be tailored to what I find during examination.
For a man with predominantly fatty fullness and good skin tone, liposuction may provide much of the correction. When there is a firm glandular component beneath the ni**le and ar**la, I commonly make an incision along the border of the ar**la and directly remove the excess glandular tissue. Frequently I combine direct excision with liposuction so I can blend the surrounding chest and create a smooth, natural, masculine contour. These are well-established approaches to male breast reduction.
At the other end of the spectrum are men with very large breasts and significant excess skin—sometimes following major weight loss. In these cases, simply removing fat and gland is not enough because the remaining skin would hang. A more extensive skin-resection procedure may be required, sometimes with removal and repositioning of the ni**le-ar**la complex as a free ni**le graft. The tradeoff is a longer scar, but in the properly selected patient, the improvement in chest contour can be dramatic and well worth the scar.
What makes gynecomastia surgery particularly rewarding is how much the problem can affect a man's everyday life. Some men have spent years avoiding swimming pools, beaches, fitted shirts or taking their shirts off in front of other people. ASPS likewise notes the significant self-consciousness the condition can cause.
For properly selected patients, surgical correction can produce a flatter, firmer and more masculine chest. Results are generally long lasting, provided the underlying cause has been addressed and weight remains reasonably stable.
Like Dr. Bunkis’ ten minutes in the voting booth, sometimes one carefully considered decision can make a difference that lasts for years. https://orangecountyplasticsurgery.com/choices-that-matter/

09/28/2026

One Recovery, A More Complete Result
By Dr. Deborah Ekstrom
Orange County Plastic Surgery, Corona del Mar/Newport Beach

Just as Dr. Bunkis described how many separate pieces had to come together during this week's presidential visit, plastic surgery sometimes benefits from carefully coordinating several procedures to accomplish one overall goal.
Consider a patient concerned about aging of the face. She may have bags beneath her eyes, drooping brows and significant laxity of her neck and jawline.
We certainly could correct those concerns separately—a lower blepharoplasty this year, brow lift next year and facelift later.
But if the patient is healthy, genuinely wants all three corrections and is an appropriate surgical candidate, performing complementary procedures together can have significant advantages.
First is balance. Correcting the neck while ignoring significantly aging eyelids or brows may improve one area while leaving another looking disproportionately older. Addressing related areas simultaneously can produce a more harmonious overall rejuvenation.
Second is recovery time. Each facial procedure may produce approximately ten days of noticeable swelling or bruising before many patients feel comfortable returning to normal social activities. Three separate operations can therefore mean three separate recovery periods. Combining appropriate procedures can consolidate much of that recovery into one period.
There can also be financial efficiencies because the patient isn't repeatedly paying certain facility, anesthesia and other expenses associated with separate operations.
The same principle applies to a Mommy Makeover. Changes following pregnancy may involve both the abdomen and breasts. Depending upon the patient's needs, abdominal treatment might include a tummy tuck, liposuction or both, while breast surgery might involve augmentation, reduction, lifting—or a combination. Treating complementary areas together can produce a more balanced transformation with one principal recovery period.
Another classic example is rhinoplasty combined with chin augmentation. Sometimes improving the nose alone isn't the entire answer because facial harmony depends upon the relationship between the nose, chin and overall facial profile.
But there is an important limit: more is not always better.
Patients who have experienced massive weight loss may have concerns involving their abdomen, breasts, arms, thighs and other areas. Trying to correct everything during one operation can create unnecessary risk. In our practice, we generally stage extensive procedures when the anticipated operative time would become excessive, commonly keeping an individual operative session within approximately six hours based on the patient's circumstances and procedures involved.
This is also where team surgery can be advantageous. Because Dr. Bunkis and I frequently operate together, two experienced plastic surgeons can accomplish complementary portions of an operation efficiently while still respecting appropriate operative-time and safety considerations.
The objective is never to see how much surgery we can do at once.
It is to determine which procedures belong together, which should remain separate, and how we can achieve the patient's goals as safely and efficiently as possible.
As Dr. Bunkis also demonstrated this week, when the right pieces are thoughtfully coordinated, the whole can sometimes be greater than the sum of its parts. https://orangecountyplasticsurgery.com/better-together-the-power-of-coordination/

09/21/2026

A Seasonal Reset for Your Skin
By Dr. Deborah Ekstrom
Orange County Plastic Surgery, Corona del Mar/Newport Beach

Just as Dr. Bunkis and I discovered that occasionally we need to reset ourselves, our skin can sometimes benefit from a reset as well.
As the days become shorter and we generally spend less time in intense sunlight, fall and winter can be excellent seasons to consider skin resurfacing. Years of Southern California sunshine can leave their calling cards: uneven pigmentation, brown spots, fine lines, rough texture and other visible signs of photodamage.
The appropriate resurfacing treatment depends upon the patient's skin type, degree of sun damage, goals and tolerance for downtime.
TCA (trichloroacetic acid) peels are available in different concentrations and depths. A 20% TCA peel provides a lighter resurfacing and may be appropriate for relatively mild pigmentation and texture irregularities. A 35% TCA peel penetrates more deeply and can produce more significant improvement in sun damage, pigmentation and fine lines—but also requires more healing time and careful patient selection.
Phenol peels represent a much deeper form of chemical resurfacing. They can produce dramatic improvement in appropriately selected patients with significant photoaging and deeper wrinkles, but the increased depth also means greater downtime and greater potential risks. These are not treatments to be undertaken casually and are not appropriate for every skin type or every patient.
Fractional laser resurfacing takes a different approach. Instead of treating the entire skin surface uniformly, fractional technology creates microscopic treatment zones while leaving intervening areas of skin relatively intact. Depending upon whether an ablative or non-ablative fractional laser is used and the treatment settings selected, we can tailor the procedure to the patient's skin and desired balance between improvement and recovery time.
Preparation matters. Patients may be placed on a physician-directed skin-care regimen beforehand, and some patients require antiviral medication when resurfacing around the mouth or face. Certain medications, medical conditions, history of abnormal scarring and skin types can also influence which treatment is safest.
After treatment, meticulous skin care is essential. Depending upon the procedure, expect redness, peeling, swelling or crusting during healing. Follow your surgeon's cleansing and moisturizing instructions carefully—and resist the temptation to pick peeling skin!
Most importantly, resurfaced skin must be protected from the sun. Daily broad-spectrum sunscreen, hats and sensible sun avoidance help preserve the improvement you worked so hard to achieve.
Whether it is a quiet morning fishing off Catalina or restoring healthier-looking skin after years in the California sun, sometimes a carefully chosen reset is exactly what we need. https://orangecountyplasticsurgery.com/reset-refresh-renew/

09/14/2026

The Human Body as a Work of Art
By Dr. Deborah Ekstrom
Orange County Plastic Surgery, Corona del Mar/Newport Beach

I often tell my patients that we are God's walking art. And just as Dr. Bunkis and I can look at the same painting and have completely different reactions, there is no single body shape that everyone considers ideal.
Some people love long, slender legs. Others prefer calves that look fuller, shapelier or more muscular. In plastic surgery, what matters is not creating the body your surgeon finds most attractive. Our job is to understand your vision and your expectations and determine whether we can safely help you achieve them.
For patients bothered by disproportionately thin or poorly developed calves, one option is calf augmentation with implants. Orange County Plastic Surgery is one of the relatively few practices in the Newport Beach area performing body implant procedures including calf, buttock and pectoral augmentation.
Calf implants have been used for decades. They can provide cosmetic enhancement but historically have also been used to improve contour deficiencies resulting from congenital conditions, disease or injury – for example, we have put calf implants into patients unilaterally to correct asymmetries caused by polio of being born with a club foot on one side.
Planning begins with the patient standing so that the natural contours of the leg can be carefully marked. Depending upon the desired result, pockets can be designed over the medial and lateral heads of the gastrocnemius muscle. The medial implant is generally larger and extends farther down the calf, reflecting normal calf anatomy.
Under light general anesthesia, a transverse incision is made within the natural crease behind the knee. This location generally heals extremely well and can become quite inconspicuous. Using blunt dissection, a pocket is created over the appropriate muscle and the implant is carefully positioned.
Unlike breast implants, calf implants are made from soft, solid silicone elastomer. They do not contain a liquid or gel center and therefore are not subject to the same concerns about shell rupture or leakage. In the absence of a problem, they are not routinely replaced simply because a certain number of years has passed.
After the incisions are closed, a supportive bulky dressing is applied. We generally keep the knees slightly flexed during the first ten days to minimize tension on the incisions and give them the best opportunity to heal beautifully.
Whether we are discussing a Renaissance painting, a piece of modern art—or the contours of the human body—the lesson is much the same:
There isn't just one definition of beauty. The most important eye of the beholder is your own.

Some people love long, slender legs. Others prefer calves that look fuller, shapelier or more muscular. In plastic surgery, what matters is not creating the body your surgeon finds most attractive. Our job is to understand your vision and your expectations and determine whether we can safely help yo...

09/07/2026

Back to Basics: Liposuction and the Evolution of Body Contouring
By Dr. Deborah Ekstrom
Orange County Plastic Surgery, Corona del Mar/Newport Beach

After discussing some of the newer procedures available in plastic surgery in recent newsletters, I thought Labor Day was a good opportunity to go back to basics and discuss one of the procedures that truly transformed our specialty: liposuction.
When I entered plastic surgery, modern liposuction was just beginning to emerge. Early techniques were introduced in Europe during the 1970s, and by the early 1980s liposuction was gaining acceptance in the United States. What followed was extraordinary. Improvements in cannulas, anesthesia, fluid management and surgical techniques helped turn liposuction into one of the most commonly performed cosmetic surgical procedures.
Yet one misconception remains: liposuction is not a weight-loss operation.
The ideal patient is generally healthy, reasonably close to his or her desired weight, has good skin elasticity, but has localized fat deposits that simply do not respond adequately to diet and exercise. Genetics plays a major role in where our bodies store fat, which explains why even very fit people can have stubborn areas they simply cannot exercise away.
Common treatment areas include the abdomen, waist and “love handles,” hips, thighs, back, upper arms, knees, and beneath the chin. In men, the neck, abdomen and flanks are particularly common concerns.
During liposuction, small incisions are made in inconspicuous locations and a thin tube called a cannula is used to loosen and remove unwanted fat. Today's techniques allow us to sculpt rather than simply “remove fat,” creating smoother transitions and more natural proportions.
Most patients are surprised by how quickly they can resume normal activities. Swelling and bruising are expected, compression garments are commonly worn during recovery, and strenuous exercise must wait—but many patients are back to routine activities relatively quickly. The final contour continues to improve as swelling subsides over the following weeks and months.
Perhaps the most important point is that good liposuction is about shape, not pounds. Removing a relatively modest amount of fat from precisely the right places can sometimes produce a dramatic change in proportion—one that may change how clothing fits and how a patient feels about his or her silhouette.
As summer draws to a close and we transition into another season, it is a good reminder that sometimes relatively small changes can make a surprisingly large difference.
And that is as true in plastic surgery as it is in life.

https://orangecountyplasticsurgery.com/making-the-most-of-lifes-transitions/