Plastic Surgery Questions

GENERAL QUESTIONS ABOUT DR. EDWARDS AND HIS PRACTICE

1. Are you board-certified? How do I verify this?
I am board-certified by the American Board of Plastic Surgery and the American Board of Surgery. These require re-certification every 10 years and I have re-certified in each of these boards in my effort to ensure currency. I will provide information below to show how you can verify if a physician is board-certified in the specialty you are seeing them for. Your plastic surgeon should be board certified by the American Board of Plastic Surgery (www.abplsurg.org) (215-587-9322). This board has strict criteria in order to become board certified. It is one of the 24 member boards of the American Board of Medical Specialties, (www.ABMS.org). They provide on-line verification of board certification (www.ABMS.org) or (866) ASK-ABMS. A physician can be certified by other boards representing their area of training, but they may not have the proper training to do cosmetic surgical procedures. A series of weekend courses and seminars cannot begin to replace 2 or 3 years of a plastic surgery residency. To be board certified in plastic surgery a doctor must graduate from an accredited medical school, do residency training in an accredited program, and complete an approved residency in plastic and reconstructive surgery. They also must practice a minimum of two years after graduation, and pass both written and oral examinations in plastic surgery. Board certification takes approximately about 8 years after graduation from medical school.
There is a difference between state medical license and board certified in plastic surgery. Any doctor can get apply for a state medical license, but they do not necessarily have the training in plastic surgery.

2. What is the American Society of Plastic Surgeons (ASPS), and who is a member?
This society is the only society which includes only board certified and credentialed plastic surgeons from around the world. The society comprises more than 95% of all plastic surgeons. The American Society of Plastic Surgeons represents 97% of all physicians certified by the American Board of Plastic Surgery. You can view this site, or call the ASPS to determine the status of an individual plastic surgeon at www.plasticsurgery.org or by calling 800-635-0635.

3. What is the American Society for Aesthetic Plastic Surgery (ASAPS), and who can be a member?
The American Society for Aesthetic Plastic Surgery (ASAPS) www.surgery.org (1-888-272-7711) is the society of board-certified plastic surgeons who chose to focus their practice on aesthetic or cosmetic surgery. ASAPS member surgeons are fully trained in all facets of reconstructive procedures as well.

4. Why is it important that the board a doctor is certified by is recognized by the American Board of Medical Specialties?
The American Board of Medical Specialties, (ABMS), (http://www.abms.org) is a not-for-profit organization that assists 24 approved medical specialty boards in the development and use of standards in the ongoing evaluation and certification of physicians. ABMS, recognized as the “gold standard” in physician certification, believes higher standards for physicians means better care for patients. You can feel confident that your board-certified plastic surgeon has had the proper training to safely care for you in a state of the art manner. Board-certified plastic surgeons should operate only in accredited surgical centers staffed by well-trained and credentialed providers.

5. What are the other boards or societies I see in other doctor’s advertisements such as The American Board of Cosmetic Surgery, The American Society of Laser Medicine, The Lipoplasty Society, etc.?
There are boards or societies that can be confusing to the patient such as the Board of Cosmetic Surgery. This board is not recognized by the American Board of Medical Specialties and the physicians listing this certification are typically not plastic surgeons and can be doctors trained in virtually any field such as Pediatrics, Family Practice, ENT, OB/GYN, etc. These doctors will typically not be board certified by the American Board of Plastic Surgery.

6. What is the difference between a Cosmetic Surgeon and a Plastic Surgeon?
A Plastic Surgeon is both a reconstructive and a cosmetic surgeon who has completed training in an accredited plastic surgery residency. The techniques employed in aesthetic surgery are derived from those used in reconstructive surgery. In fact, aesthetic surgery is an extension of reconstructive surgery. It requires competent surgical skill, a sense of harmony of the body parts and good aesthetic judgment on the part of the surgeon. It is common for many plastic surgeons to devote their time to aesthetic/cosmetic surgery procedures. Typical cosmetic surgery procedures include Rhinoplasty (cosmetic surgery on the nose), Blepharoplasty (cosmetic surgery on the eyelids), Face Lift (cosmetic surgery to tighten facial tissue), all facets of breast surgery to correct asymmetry, increase or decrease the size of the breast as well as tightening and lifting procedures, and all body contouring procedures (Tummy Tuck, Body Lifts, Liposuction, etc.) .
A cosmetic surgeon is a physician who has not completed a plastic surgery residency who performs cosmetic surgery procedures. This can be an OB/GYN, General Surgeon, Family Practice, Emergency Room Physician, etc. They may state that they are board certified which they may be, but not by the American Board of Plastic Surgery.

7. Where do you perform your surgical procedures?
I am credentialed at multiple hospitals and accredited out-patient surgical facilities to operate but the majority of my surgery is performed in the free-standing fully-accredited surgical centers. Plastic surgery can be performed in any of several different types of facilities. The actual location used depends largely on the individual surgeon. It is important to realize that, from the standpoint of safety and results, no accredited surgical facility is inherently superior to any other. Some surgeons operate exclusively (or nearly so) in an office-based or other free-standing surgical facility, some operate exclusively in hospitals, and many operate in either environment. Sometimes it depends on the procedure (with larger, longer, or more complicated procedures being done in a hospital) and sometimes it depends on the patient (the patient’s preference, or if there are certain medical conditions that are best monitored in a hospital setting). Financial considerations may be a factor, since plastic surgery procedures can often be performed more cost-effectively in an office or outpatient setting. For these and many other reasons, there has been a dramatic shift towards office and outpatient surgery over the past decade or so. As always, there are few simple answers. What matters most is that the surgeon and team are capable, caring, and vigilant. If the procedure is being performed in the plastic surgeon’s office, be sure that the facility is accredited. The American Association for Accreditation for Ambulatory Surgery Facilities (AAAASF) www.aaaasf.org is one of the nationally recognized agencies that inspects and certifies surgical facilities. This is a voluntary program of inspection and accreditation in some states and is mandatory in others in surgery facilities to ensure safety and excellence in quality care for patients.

8. Is it safe to have surgery in an out-patient surgical facility or an office-based surgery setting?
The answer is “Yes” – even though precise statistics are hard to come by for any type of facility, including hospitals. There are several organizations that have established standards for office and outpatient facilities in an ongoing effort to maintain and improve safety. One of these is the American Association for the Accreditation of Ambulatory Surgical Facilities (www.aaaasf.org). Offices and outpatient facilities that have received accreditation from this or a similar organization have established and/or adopted standardized protocols and routines – similar to those used in hospitals – and have been subjected to rigorous inspections that examine a wide range of issues, from safety equipment and procedures (like backup power and emergency medications) to office layout, staffing, and record-keeping. Already mandatory in some states, such accreditation may eventually become so everywhere. In planning your surgery, therefore, you may want to add “Accreditation” as something to consider.

9. Who will perform anesthesia for your patients?
I work exclusively with a board-certified anesthesiologist who has extensive experience in provision of all forms of anesthesia for plastic surgery patients. Advances in anesthesia have facilitated outpatient procedures. Newer medications are stronger but shorter-acting, which allow for tighter control of the patient during the procedure and a faster “wake-up” afterwards. This is an important question to ask your surgeon.

10. Who will recover me as I wake from my surgical procedure?
Whether in a hospital or out-patient surgery setting, my patients will always be recovered by a registered nurse with experience in post-operative care. This is a very important point to consider because if you do not inquire, your recovery may be conducted by a medical assistant lacking the proper training. Your safety should be the most important factor as you consider your options for elective plastic surgery.

11. If I decide to have surgery with you, what will the schedule be for pre- and post-operative appointments?
Aside from your comprehensive pre-operative appointment your post-operative care will consist of a visit to the office on the day after surgery, one week after surgery, at two weeks after surgery and then at the 2 month point. We will be happy to see you any time in the interim if there are questions or concerns. Either my office staff or I am available 24/7 for questions or concerns. After your 2 month post-op visit, I typically ask you to return at one year after surgery as well.

QUESTIONS ABOUT BREAST SURGERY

12. Do you generally place the implants above or below the muscle, and why?
My preference is to place the implants in the partially sub-muscular position because I feel it lends to a more natural overall breast look post-operatively. I also feel that in most patients leaving the suspending ligaments in place that connect the muscle to the skin of the breast (Cooper’s Ligaments); more support of the overall breast is maintained. However, the placement of a breast implant above or below the muscle is determined individually for each patient after a careful discussion of your goals followed by a comprehensive examination. There is a different appearance to the breast after each procedure and patients will have their input in this decision as well.

13. What is breast ptosis?
Ptosis is a term that means droopiness or sagginess. There are degrees of how droopy the breast can be (see photos below). This degree of droopiness will determine if a lift procedure needs to be performed along with a breast implant. Ptosis is graded I through IV.

GRADE I PTOSIS	GRADE II PTOSIS	GRADE III PTOSIS

14. How do I know if I should have a breast lift with my breast augmentation?
The laxity (sagginess) of your breast tissue will determine if you need a breast lift or not. The best way to gauge this ptosis is by looking at the position of your nipple (at eye level with your breasts) in relation to the position of the fold under the breast. This is shown in the diagrams accompanying the previous question. A breast implant can be placed in any degree of ptosis but what it will look like afterwards is the important question to answer. If you have too much laxity of your breast tissue and skin, this will “hang off” your breast after implantation under the muscle. If the implant is placed above the muscle in an effort to try to lift the breast in the presence of ptosis, the implant will eventually fill the breast envelope and hang lower potentially yielding what is referred to as a rock-in-the-sock or snoopy nose deformity.

15. What types of breast implants are available in the United States?
Two manufacturers currently make FDA approved implants in the US.The manufacturers are Allergan (formerly McGhan & Inamed) and Mentor. These companies manufacture a variety of products, which include both saline and silicone filled implants. These are both made in a variety of sizes, and shapes. The exact implant size, shape and texture should be discussed with your plastic surgeon. High profile, anatomic, expandable implants are available and the use is dependent on what your desires are, and the pre-operative breast appearance.

16. What type and style of implants do you recommend for me?
This decision is only made after discussion with you and after allowing you to see and feel the options available to you. The vast majority of my patients have smooth round implants used because my experience has been that a softer result is achieved this way with proper post-operative massage. Many techniques have been developed over the years to decrease the scar tissue (capsular contracture) around breast implants. Originally it was thought that a textured shell may decrease the rate of capsular contracture, but this in fact is probably not true. The rate of rippling is probably less with a smooth implant and the deflation rate is also presumed to possibly be lower than with a textured implant. Round implants are used much more commonly than anatomic or “breast shaped” implants. Shaped implants can also shift or rotate causing an unnatural appearance, and possibly needing a re-operation.

17. What are expandable breast implants?
The Spectrum breast implants are available from Mentor Corporation. These implants are manufactured in both smooth and textured. They have a small removable “port or fill tube” which is left in the patient at the time of the surgery. The implant can be either made larger or smaller while this valve is still in place by using sterile technique to place a needle in this port through the skin infuse or remove saline. This fill tube may be removed after the breast augmentation. The need for a procedure to remove the fill tube is one disadvantage to using this implant although this can typically be performed under local anesthesia in your plastic surgeon’s office. The advantage is that size can be manipulated after surgery to meet the desires of the patient. These implants do have a slightly higher deflation rate than other implants in my experience.

18. What are the warranties for breast implants? Do they differ from company to company?
Both Mentor and Allergan have similar warranties on their implants. In general, if the implant deflates, the patient will receive: replacement of the implant (for lifetime), and $1200 paid toward the surgical fee, anesthesia etc. if the deflation occurs within 10 years of implantation. The warranty is not valid if: a) the patient wants a replacement for cosmetic reasons, b) the deflation or rupture is secondary to a surgical procedure, c) the implants are replaced because of capsular contracture. The warranty does not extend to the opposite side implant in the event that one implant ruptures or leaks. An extended warranty is available for a nominal fee and is an agreement between you and the implant manufacturer. This extended warranty typically allows for replacement of both implants with a change in implant size if desired. In addition to this the financial compensation in doubled to $2400 if it occurs within ten years of implantation. The specifics of the warranties should be discussed with you by your surgeon and his staff.

19. If I use saline implants, would you “over-inflate” my implants? What are the benefits of this, and what are potential problems associated with over-filling?
Saline implants have a recommended fill range from the manufacturer, typically 20-100cc depending on the manufacturer and implant size. What this means is that an implant has a specified recommended lowest fill volume and a maximum fill recommendation. Over-filling, in my opinion represents exceeding the upper limit of fill volume. The more an implant is over-filled, the more firm it will feel. Additionally, the more you over fill an implant above its recommended fill volume, the more spherical it will appear.

20. How long do implants last?
The data on implant longevity is variable. Implant leakage is usually caused by a leak in the valve area or it may be due to a tear or hole in the implant which can occur over time as a result of fold fatigue. If a saline implant leaks, the salt water is the same composition as your body fluids and it is absorbed by the body with no adverse effects. Many women can get a lifetime out of their implants with no exchange needed, but it is best to think that you may need an implant exchange at sometime in your life because they are not considered lifetime devices. Implant leakage reports between 1% to 5% per year.

21. Why do breast implants need to be replaced?
The only reason to replace implants is if there is a problem with them such as deflation, capsular contracture, a change in shape or position, asymmetry, or in a patient who is unhappy with size or position. Current recommendations by the FDA regarding studying a silicone implant are that you have a breast MRI 3 years after placement and then every 2 years thereafter to evaluate the integrity of the implant. If your implant is intact, your breasts are soft and you are happy with their size and shape, I suggest you not change them for changes sake.

22. What is the best way for me to determine the size implant I will need to go from where I am to where I want to be?
This is a critical decision because you really only have one chance to have your first breast augmentation. My method of sizing begins with a discussion of your goals followed by a physical exam to determine the dimensions of your chest, breast and over all body habitus. Putting these together I then allow you to place the actual sized breast implants into a sports bra under a t-shirt after which you look in a full-length mirror. This is by no means a perfect predictor but my experience with thousands of patients through their sizing and peri-operative experience has found the vast majority of women very satisfied with their results.

23. Is there a good way for me to measure different sizes, and “try them out” when I am at home?
There are a variety of sizing methods described to be used at home such as the rice test where you place a given volume of rice in a stocking and place this in your bra. This is a poor predictor of final outcome in my opinion but can give you somewhat of an idea of volume you are seeking to be discussed at your consultation. This does not take into account the different profiles of implants as well.

24. Where would you make my incision, and how much of a scar should I expect to remain visible over time?
The vast majority of my implants are placed through the inframammary crease where I feel I can create a more precise pocket which I feel yields a better long term position and result. There are however a few options for implant placement in the primary breast augmentation. Possible incision locations include periareolar (around the nipple), inframammary (in the fold beneath the breast), transaxillary (in the hollow of the armpit), and transumbilical (through the belly button). *NOTE – The transumbilical approach may void the replacement policy of some implant manufacturers. The most commonly used incision is inframammary but this depends on your plastic surgeon. Many plastic surgeons use this incision because it arguably gives good control in placement of the implants and the incision is usually not visible although with any incision, there will be a scar. Some plastic surgeons feel that there may be more of a chance in alteration of sensation utilizing this incision as well as a questionable decrease in the ability to breast feed in the future. Some plastic surgeons feel that there may be a higher rate of capsular contracture due to an increased exposure to bacteria found in the patient’s milk ducts. The transaxillary incision is a procedure in which an incision is made in the armpit. Some plastic surgeons feel that this incision gives less implant placement control. The Transumbilical (TUBA) procedure uses an incision inside the umbilicus (belly button). Many plastic surgeons feel that the disadvantages outweigh the advantages.

25. What is the risk for decrease or absence of nipple sensation after surgery?
In my patient experience the risk of loss of nipple sensation is less than 1% of all cases. There is a risk of decreased sensation of the breast skin and nipple with any breast surgery although some plastic surgeons feel the risk is higher with an incision around the areola. Additionally, larger volume implants create additional stretch on your tissue and may cause a change in or loss if sensation.

26. Can having breast augmentation affect my ability to breast-feed in the future? Is breast-feeding safe for women who have breast implants? Should I have my breast augmentation only after I am done having children?
A large percentage of women have breast augmentation before having children (greater than 50%). Although it is variable, in most cases breast implants do not interfere with breast-feeding. This is especially true when the implants are placed sub-pectorally (partially under the muscle). Some stretching and residual sagginess of your natural breasts can occur after pregnancy. This will depend on how large your breasts become, how long you choose to breast feed, and above all else, your genetic predisposition of natural skin elasticity. If women are actively trying to get pregnant, it is best to wait on breast augmentation surgery until after that pregnancy.

27. How long after breast feeding can I have a breast augmentation?
As long as you have no on-going lactation I ask my patients to wait at least 3 months from the cessation of milk production. The risk is that breast milk may accumulate around the implant creating a difficult problem to correct.

28. Can I get stretch marks from breast augmentation surgery? Is there anything I can do to prevent them or make them go away sooner?
Yes you can get stretch marks from breast augmentation surgery. It depends on all the factors mentioned above. These are the tightness of your breast tissue to start with, the size of the breast implant that will be used, and your genetic predisposition. Some women developed stretch marks with puberty or previous pregnancy. A stretch mark is an actual tear in the dermis of the skin which occurs from stress. They are typically red or purple to start with because of the blood vessels your body uses to try to repair the injury. As the stretch mark matures it will fade because the blood vessels became less dense there.

29. What are additional considerations regarding mammograms and breast cancer detection for women with breast implants?
Some literature will state that as much as 30% of the breast tissue cannot be visualized with a breast implant in place. Radiologists I have spoken with appreciate an implant in the partially sub-muscular position because there is a natural tissue barrier between the implant and breast tissue in the upper breast tissue. It is very important to continue with the recommended screening techniques such as a monthly self-breast exam and mammograms as recommended by the American Cancer Society.

30. Am I too old or too young for a breast augmentation?
The average age for breast augmentation is between 19 and 34 years of age. Many patients are 35-50 (35%) and about 3% are older than 51. The FDA will recommend against cosmetic breast augmentation in a woman under age 18 (it is acceptable to do reconstructive and corrective surgery though). If health allows, there is no age cut off, and I have performed breast augmentations in patients in their 60’s. As women age, it is more likely that a breast lift may be needed. A breast lift procedure (mastopexy) can be performed either with or without a breast augmentation. Depending on your medical history, you may be asked to have additional testing performed such as an electrocardiogram. The purpose is to ensure your safety as best possible.

31. What are the potential complications of this procedure, given my individual circumstances, and what can be done to minimize these? (i.e., infection, capsular contracture, implants rippling or wrinkling, implants deflation, hematoma, and seroma).
Thankfully complications that can occur with a breast augmentation surgery are infrequent but it is good for you to have a sense of what they may be should they occur in your case.

• Bleeding around a breast implant is called a hematoma and if this does occur you will most likely need to be taken back to the operating room to drain the blood. You will be given strict activity restrictions to follow after surgery. It is vitally important that you follow these to help decrease the chance of complications.
• Infection of a breast implant can be a devastating complication because it typically requires that the implant(s) be removed and left out for approximately 3 months before a new implant can be placed. My patients are given a dose of antibiotics prior to surgery in the pre-operative area and then a prescription is given for a five day course afterwards.
• Capsular contracture occurs when the scar that your body builds around the implant (the capsule) becomes tight which can make the breast assume a different shape, shift to a higher position or become painful. I have my patients massage their implants starting 1 week after surgery. This, in addition to a sub-muscular placement tends to keep the occurrence of a capsular contracture low.
• Implant malposition too low, too high or to the sides can occur and the best means of decreasing the chance that this occurs is by precise pocket selection. Mild malposition too high can often be corrected by massage but if the malposition is too low or to the side, this may require surgery to close the pocket with permanent suture.
• Synmastia is when the pockets of the 2 implants communicate. The is as well a complication that is better prevented by proper implant selection and precise pocket creation.
• Rippling of the implant can occur if the tissue overlying the implant is thin allowing the ripples in the implant to be seen. This is more common in the thicker-shelled textured implant, in the sub-glandular (above the muscle) placement and with saline implants.

32. Will I have drains?
I do not routinely use drains in a primary breast augmentation. If you were to wake from your surgery with drains in place, there was probably more oozing than I was comfortable with after the implants were placed.

33. When can I shower or take a bath? What about swimming or hot tubs?
I ask my patients to leave their dressings in place until I see them the following morning. At that time the dressings will be removed and after examining you, you will be placed back into your sports bra in addition to the bra strap that we place over the upper portion of your breasts which you wear for 2 weeks. You are allowed to shower once you get home. You are not allowed to immerse your incisions under any water (pool, spa, bathtub, lake, Jacuzzi, etc.) for 4 weeks after surgery as long as you are healing well.

34. How much pain can I expect to have? What methods do you use for pain control?
The amount of pain you experience will depend upon a number of factors not the least of which is your tolerance to pain. I place a local anesthetic around the borders of the breast during surgery and always inject a long-acting numbing medicine into the pocket around the implant. You are discharged with a narcotic pain medication as well as a muscle relaxant with specific instructions in how to use them. Narcotic pain medications serve to decrease your pain but they can also slow down your GI tract leading to constipation which should be avoided.

35. Do you use pain pumps?
I have used pain pumps with breast implant surgery but typically only at a patient’s request. It will stay in place for a little over 3 days and is removed in the office. The pain pump is filled with a long—acting numbing medication to decrease the need for narcotic pain medication. This can be used at additional costs to the patient.

36. Do I need to take antibiotics before and after surgery?
No good studies exist to determine the length of time a patient should take antibiotics, but it is common to take antibiotics for a short course after the breast augmentation procedure as mentioned above. It is questionable whether antibiotics are needed when a patient undergoes other procedures after a breast augmentation has been performed. Antibiotics should probably be used when a patient undergoes any procedure in which “bacteria” may be released into the blood stream. These include, but are not limited to: Dental work, colonoscopy, gynecologic procedures, other major surgeries, and others. My recommendation is that a breast augmentation be given a single dose of these preventative antibiotics to be taken within one hour of the procedure.

37. Are there any other adverse, long-term effects of having breast implants?
The FDA studied the current generation silicone gel-filled implants for 14 years with thousands of patients and no long term ill affects were noted. The complications that can be seen with breast implants are local in nature and have to do with capsular contracture and issues with your soft tissues. There is no scientific data to support that breast implants (saline or silicone) have a role in any connective tissue disease or systemic problems. For more detailed information you can visit www.breastimplantsafety.org.

38. Do you recommend I massage my implants post-operatively?
I have all of my patients massage their breasts after augmentation with smooth round implants. I feel this leads to a softer and more natural result. I have you start massaging approximately one week after surgery as long as you are healing well and then you are followed closely to ensure it is having the desired affect.

39. Can you recommend any homeopathic or natural remedies that will aid in minimizing scarring, bruising, and swelling, and that can speed up my recovery process?
I have my patients take a course of Arnica Montana (see next question) which I feel aids in decreasing bruising and swelling in the post-operative period. Arnica has been used in homeopathic settings for many years.

40. What is Arnica and should I take it?
Arnica is a homeopathic medication which is used to reduce pain, swelling, and bruising. Arnica can be taken by pill or cream form. I have encountered two patients out of hundreds who I have given it to who developed headaches with Arnica although there is no trade literature that describes this.

41. When can I resume normal activities after breast augmentation? What about exercise?
I ask that you not lift greater than 10 pounds for the first six weeks after surgery and that you avoid any bouncing motions of your breasts during the same time you are healing. You should remain in an exercise bra or a good supportive bra for the first six weeks after surgery 24 hours a day. After this, as long as you are healing well, you can sleep without a bra. Let common sense be your guide. If something hurts or is uncomfortable, modify how you do it or don’t do it.

42. How long does the procedure itself take?
Breast augmentation requires approximately 30-60 minutes of surgical time once you are under anesthesia. If other procedures are to be performed under the same anesthetic, it will take that additional time.

43. How much do you charge for this procedure?
This is best discussed at the time of your consultation because this document may not keep pace with the changes in OR, anesthesia and supply costs. At your initial consultation you will be given a comprehensive quote for the costs involved.

44. Is that an all-inclusive price for everything?
The quote that you receive at your consultation will be detailed and include all costs except those for medication and mammograms or the costs associated with any required medical clearance.

45. Are there any special instructions I should follow before and/or immediately after the surgery?
You will receive a comprehensive booklet to supplement your pre-operative appointment. We strive to educate you as best we can about the procedure and what you can expect as you recover. At each of your appointments these issues will be reviewed. Specifically your pre-operative appointment is our time to ensure that you are as prepared as we can make you and those who will be caring for you as you recover.

46. How long before having surgery would I have to schedule with you?
This depends on your schedule and any pre-operative testing that is required as well as my operative schedule. Our goal will be to try to accommodate you and your schedule as best we can. If you feel as though you want to lose weight before your surgery, it is best that you be close to your goal weight when you come in to discuss surgery.

47. Are there financing options to help pay for the surgery?
Yes. There are a variety of financing options that my office staff will be happy to review with you. I encourage you to be careful prior to signing any paperwork for financing and be as smart as you can about the terms of the agreement.