Category Archives: Cosmetics

Cosmetic Surgery questions

ASK DR NOVOA- Consider taking prophylactic antibiotics for dental procedures if you have breast implants in place.

Hi Everyone.

Breast Implant Alert!

As you all know, I am continuing to do research concerning AWAKE Breast Augmentation or Tumescent Anesthetic Breast Surgery (TABS) and the benefits of using high profile implants.

I have posted a couple of videos on the subject on under Ask Dr. Novoa.

I wanted to advise my patients of the following: If you have breast implants and you get an upper respiratory infection, ear infection, or tooth infection to include dental treatment/cleaning or tooth extraction, I am requesting that you consider taking prophylactic antibiotics.

What I have seen in a few patients, months or even years after the placement of implants is that they develop capsular contractures a few days or a few weeks after the infection. I am also recommending the prophylactic use of antibiotics for patients who put braces on their teeth after breast implants are placed.

Further, I am concerned that due to the long process of positional correction of teeth using braces, the risk of infection and seeding of bacteria, especially after an adjustment or tightening, puts patients with braces at an even higher risk of developing capsular contractures.

There is a significant amount of research documenting a link between dental caries and endocarditis (prosthetic heart valves) and the current recommendations are that these patients should take antibiotics when having work done on their teeth. In these cases, a bacterial infection from the mouth enters the circulatory system and the bacteria lodge to the prosthetic heart valves causing a sustained infection.

I believe that there is a similar link between infectious seeding from dental caries, to the lymphatic system of the head, neck and axilla, to the breast, thus causing latent infection of the breast and a rapid inflammatory response and the creation of a capsular contracture.

I am not suggesting that every patient is at risk of getting a capsular contracture, but the literature does suggest that this can occur and I have seen it a few times this year with patients who had their implants placed a few years ago.

Luckily, the use of antibiotics immediately after symptoms have appeared seems to completely reverse the symptoms, so it may be an autoimmune response, but I don’t want my patients taking any chances.

Please also remember that this is a recommendation for my patients only. Very few doctors to include plastic surgeons are looking into this link so you may get an opposing recommendation since they have not seen an association or may have thought of it as a coincidence. Since I have been looking for it and documenting it, I do believe that a link exists.


Dr. Novoa

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What is too attractive?

Hi Ladies. This FYI for all you beautiful/attractive/sexy ladies that like to dress as attractively as possible when you go to work. The Iowa Supreme Court has upheld a defense of the firing of an employee by her employer because she was “irresistibly attractive” and threatened his marriage even though there was never any sexual harassment or flirtation going on.

Although the laws of Texas are different, employers can fire employees in Texas without cause. So consider the following article before going to work.

What is even more concerning is, What if the GIRLFRIEND doesn’t like you???? In this case, it was the WIFE and marriage, but what if its the girlfriend and someone he is just dating, or that he is just interested in you but has to fire you to avoid issues of sexual harassment????


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ASK DR NOVOA- Cosmetics VS Plastics???? Who is better!

Dear Friends,

I have heard a rumor that at least one plastic surgeon is claiming to have been the first surgeon to bring AWAKE procedures to El Paso and that the reason I charge so low is because I use knock off implants rather than the implants sold by the Allergan Company.

Although i am very disappointed, I am not at all surprised by the unprofessional ethics and behavior of some of the plastic surgeons in El Paso.

In 2008, I, Dr. Novoa, a cosmetic gynecologist, was the first surgeon to perform an AWAKE Breast Augmentation, in the El Paso area. This procedure was created by Dr. Anil Gandhi and is a trademarked procedure .

After I began to do this procedure, many local plastic surgeons were in an uproar stating that AWAKE procedures was a surgical impossibility, that they were barbaric, that they were dangerous and were inferior to General Anesthesia. To this day, this is still commonly stated by Board Certified Plastic surgeons in the area despite the fact that they have never been trained on how to do the procedure and have no research to back up any of their comments. The reasons for their negative comments have been because of professional biases as well as economic losses.

Question, if you were a plastic surgeon charging $10,000 for a Breast Augmentation and a cosmetic gynecologist starting charging $3,500 for the same procedure and at the same level of difficulty, what would you do or say???

In 2010, because of all the negative pressure from the plastic surgeons, I created an instructional video which can be seen on under my name. Since this date, it has been seen 95,000 times and is considered by many as one of the best instructional videos on how to do an AWAKE Breast Augmentation. Rumor has it that even our local Board Certified Plastic surgeons have watched it in order to finally learn how AWAKE Breast Augmentation is done, which is exactly why I created it.

In 2011, that is exactly what happened, with the plastic surgeons offering AWAKE procedures despite the fact that they were doing everything in their power to stop me as a cosmetic gynecologist from doing them.

In September 2012, I published my first paper on AWAKE Breast Augmentation, called TABS or Tumescent Anesthetic Breast Augmentation. It is now considered internationally as peer reviewed paper on AWAKE Breast Augmentation.

I am currently working on two chapter in a soon to be published book on Advance Breast Augmentation and have been invited to speak in Las Vegas in January 2013 at two international cosmetic conferences on the subject of AWAKE Breast Augmentation and the use of High Profile Implants made by the Allergan Company.

Since 2008, I have performed 605 AWAKE Breast Augmentation with complication rates lower than the national average for Board Certified Plastic Surgeons.

I do not claim to be a Plastic Surgeon. I don’t want to be one, because I believe that a Cosmetic OB/GYN is a far more rounded surgeon regarding the medical needs of female patients. I consider myself to be an expert on the female sexual and reproductive specialties of medicine. I also consider myself to be an expert on complicated vaginal deliveries and Cesarean Sections.

The reason I charge lower prices is not because my practice uses inferior products, it is because I provide services based on the economical needs of the women of El Paso, Texas. How can any cosmetic surgeon claim to offer AFFORDABLE PRICES when they charge $10,000 for a procedure which is one third the annual income of most El Pasoans?????

I have put up with this for too many years. Enough is enough.

I am now asking everyone out there to help me stop this unethical behavior.

If asked, Dr. Novoa brought AWAKE Breast Augmentation to El Paso and is still the only surgeon trained by Dr. Gandhi to perform AWAKE and TABS Breast Augmentation as well as AWAKE liposuction, tummy tucks and vaginal rejuvenation surgery.

I am also asking anyone and everyone out there that has personally heard any defamatory comments made by any cosmetic or plastic surgeon about me to contact me.

I guess this is the only way to finally stop all this. What I wanted for the women of El Paso was to provide safe, effective and affordable cosmetic services. What I received back from competitors was expected but I am tired of having to deal with unethical behavior from the shadows and with them hiding behind their well-pressed white coats.


Dr. Novoa

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ASK DR NOVOA – I have heard that there is a type of breast implant that will make your breast continue to grow and can make your breasts grow up to size of watermelons. Is this true?

Unbelieveably, this is actually true. This type of implant was briefly available in the US but was pulled off the market in 2001. The implants are called polypropylene string implants (PSI). The polypropylene IS NOT CIRCULAR, rather it is yarn-like. Once placed in the breast pocket it causes irritation to the implant pocket which causes the production of serum which fills the implant pocket on a continual basis. This causes continuous expansion of the breast after surgery. The fluid must be removed on a continuous basis to keep the breasts from continuing to increase in size. Continual breast growth will eventually result in “extreme, almost cartoonish breast sizes.”

This type of implant is most commonly used by exotic dancers, such as, Chelsea Charms. Attached is a link on Youtube to see what this type of string implant can do to the breast to eventually make them grow to an incredibly large size.

This is more for FYI since PSI is no longer available in either the US or Europe.

Also, there is no other type of implant currently available that results in the continuous increase in breast size once they have been placed.

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ASK DR NOVOA – I wanted to get filler in my lips to make them look sexier. I am worried though, since I see so many movie stars with clown lips after getting filler. What is the story?

Most absorbable fillers such as Juvederm and Restylane work great when injected into lips. Although a little scary and a bit painful, most now come with lidocaine to numb the lips while the procedure is being done.

The amount of filler injected into the lips will vary between person to person. However, this amount is entirely dependent on the patient since it is done one area at a time and the patient is able to view the procedure.

So if you have ever thought of getting fillers, it does not have to end up making you look fake and it can significantly enhance the look of your lips.

The cost varies but averages about $650 per treatment. Each treatment lasts between 3-6 months.

So, if you are afraid of clowns, avoid going to Hollywood or the Circus. 🙂

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ASK DR NOVOA – I recently got breast implants but am worried because I heard they can explode if I get on a plane. Is there any truth to this?


I hear this all the time. This myth has been most recently promoted by the TV SHOW on Spike TV, called “1000 Ways to Die.” It is theoretical possible to rupture an implant with a significant amount of pressure ; however, the level of atmospheric pressure necessary to rupture an implant would have to be so great that it would cause the death of the person from other organ damage.

Again, exploding implants during a plane flight is not possible with either saline or silicone implants. So enjoy ur flight to Disneyland without fear. And feel free to skydive without a worry!!!

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ASK DR NOVOA – I work out everyday and have lost weight, but I still can’t lose weight I gained from my kids and the loose skin from my pregnancies. Do I really need a tummytuck or will liposuction fix this?

Above all else, I want to commend anyone willing to exercise in order to look their best.

Unfortunately, there comes a point that no amount of exercise will be able to get you back to your pre-pregnancy look.

IN GENERAL, if you are in a standing position and you can grab 5 inches or a handful of skin and babyfat from ur abdomen and especially each hip, this fat will rarely retract back to your pre-pregnancy figure. Mother Nature created the body to store fat in case of emergency or in the case of starvation. Your body doesn’t know the difference between a diet or starvation. One of the last places it will eliminate fat are the love handles and lower back. And yet elimination of fat in these areas can give you the “hour glass” appearance that most women look for and consider when they look at a slim person.

The tummytuck and liposuction of the love handles and lower back , a procedure called lipoabdominoplasty and body sculpturing can do what exercise will rarely be able to do, even in tri-athletes. The goal is to give you confidence to wear a bikini.

So, if you are not happen with your look and can grab a lot of skin, consider seeing both a cosmetic surgeon and your exercise trainer for optimal results.

And never stop thinking and living healthy. 🙂

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ASK DR NOVOA – How do you determine bra size?

I was surprised to find out that many ladies don’t know how a bra vs. cup size is measured. Well, here is a general way to determine the measurements.

WITH NO BRA ON, do the following:

  1. Wrap a tape measure around your body just under your armpits, around the upper part of your back. It should lay on your chest just above your breasts. Document the measurement in inches. If it is even, this is your band size. If the number is odd, add 1 to it to get your band size.

  2. Measure around your chest at the fullest point of your breasts. Make sure that the tape measure is laying flat around your entire body and does not sag in the back. Note this measurement in inches.

  3. Subtract your band measurement from Step 2 from the measurement in Step 1. The difference determines your cup size.

A difference of 0 to 0.5 inches corresponds to a AA; 1 inch to an A cup; 2 inches, B cup; 3 inches, C cup; 4 inches, D cup; 5 inches, DD or E cup; 6 inches, DDD or F cup; 7 inches, or G cup; 8 inches, or H; 9 inches or I cup; 10 inches or J.

If you want to have a breast augmentation, IN GENERAL, if you are a 36A: adding a saline implant of 300cc size increases you to a 36B; 400cc to a 36C; 500cc to a 36D; 600cc to a 36DD; 700cc to a 36DDD; 800cc to a 36G.

A great place to go to get an exact bra fitting is Dillard’s. They have a professional bra specialist that makes excellent recommendations.
And Yes, I do have patients who are 34-38 G to H sizes.

Hope this helps. 🙂

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68 year old woman gets AWAKE Breast Augmentation

AWAKE Tumescent Breast Augmentation Surgery performed on a 68 year old woman in El Paso, TX.

AWAKE Breast Augmentation- 68 year old woman

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ASK DR NOVOA – Is there any way to increase the size of a man’s penis?


This is a follow-up on last week’s cosmetic question regarding fat transfer. A seemingly popular and very expensive surgery for a man seeking to increase the size of their penis is fat transfer (via liposuction from the abdomen) to the penis. This procedure costs between $10,000-$20,000.

There are two general categories for the enlargement of the penis (1) Penis lengthing and (2) Penis thickening.

Penile lengthening: the most common technique to lengthen the penis is to cut its suspensory ligament which supports its point of insertion in the body. This results in an average increase of 1-2 inches in length. The function of the ligament is to hold its position in the pubic bone and to keep the penis pointing upwards during erection. After it is cut, that support is no longer present. A potential risk of releasing the suspensory ligament is that the accidental downward thrust of the erect penis during intercourse towards the man’s feet can literally cause the penis to “pop out” of its insertion point (penile fracture) producing extreme pain and requiring surgical correction. This most commonly occurs with the girl on top or when falling on the penis by accident when it is erect.

Increasing penile girth (thickness): The two most common techniques are

  1. injection of liposuctioned fat (fat transfer) under the skin of the penile shaft.

  2. placing grafts of skin and fat within the penile shaft.

The increase in girth or width can be significant, increasing the size of the shaft up to 2 inches (average start size 5 inches increasing to 7 inches around in diameter). However, the appearance of the penis after a fat transfer can be very strange to say the least. Because of the anatomy of the penis, fat cannot be transferred into the head of the penis, thus only increasing the size of the shaft and not the head. The best way to explain the look after this type of surgery is that the penis looks like a “pig in a blanket.” The results can be disappointing. Up to 90% of the fat can be reabsorbed within a year of the transfer. Grafts may do better but failure of the graft can lead to skin breakdown and ulceration of the penis. Also, fat absorption may not be uniform in appearance causing the penis to appear deformed with irregular fatty lumps throughout the shaft.

As with any cosmetic surgery, “Beauty is in the eye of the Beholder.” However, being able to increase the size of a penis l- 2 inches longer or 1-2 inches wider or both may not be worth it if its ends up making the penis look like it got reconstructed from a can of Spam.

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