Total Body Surgical Blog

LIPOSUCTION: FACTS AND MYTHS

GENETICS

Liposuction, like all cosmetic procedures, is a combination of skill and artistry.  It sounds hokey, but just as each person is taught they are a snowflake in grade school, every individual requires a very personalized approach when addressing areas of fat.  Now, typically speaking, many women usually tend to focus their problem areas as being the lower abdomen, flanks (the dreaded muffin top), thighs, and arms.  Meanwhile, guys tend to focus on their chest and belly.  Obviously, crossover does occur regarding areas; and to be perfectly honest, it all depends on how we pick our parents! 

The dreaded "muffin top"

  "love handles"...not so lovely

Fatty thighs...saddle bags, inner thighs, anterior thigh, and fatty knees.

AM I A CANDIDATE?

Many people will begin to notice collections of fat post baby that they just can’t get rid of.  Others will turn to liposuction when they have pesky areas that just won’t disappear,  no matter how much exercise and dieting they do.  Still others want extra help in appearance for a wedding or class reunion coming up.  Whatever the case, liposuction is a spectacular avenue to help someone on the  road to the body that they envision.

JUST A TOOL

It should be emphasized that liposuction is only a tool.  Specifically, it is NOT a weightloss technique.  Without a doubt, one will lose weight from the procedure, but its main focus is actually to shape by removal of fat. In addition, once a person has  liposuction, that area where fat is removed means that it is gone for good.  However, this doesn’t mean you’re free to go and gain weight- quite the contrary!  In fact, weight gain will go to other areas of your body, making it look abnormal.  We encourage our liposuction patients to utilize this opportunity as a complete jumpstart to a new and healthy lifestyle. From a very positive point of view, if fat is removed by liposuction from problematic areas, this also means that calories burned by diet and exercise in the future will then be focused on other areas, rather than those where fat has been removed. 

WHAT IS THE PROCESS?

STEP 1

Essentially, the way liposuction done at Total Body Surgical is a 3 step process.  Though it is not commonly practiced outside of the East and West Coasts, our liposuction is usually performed with what is called the  tumescent technique.  It has also been termed, “lunchtime lipo”, “Smartlipo”, or “laser lipo”.  Patients remain awake throughout the procedure, receiving local anesthesia in the areas of treatment. This allows the patient to communicate with the physician throughout the procedure. It also helps physicians provide great results by allowing them to easily position the patient in the best way possible to treat each area. For those that may be concerned about being awake during the procedure, patients are provided medications to assist in their relaxation and comfort.

In addition, the tumescent technique allows the patient to avoid the general anesthetic that is so hard on your health.  Many times, the recovery from a surgery is not so much related to the procedure, but rather to the administration of the general anesthetic.  Essentially, tumescent technique cuts your recovery time by at least 50%.  Meaning, it is a quicker return to work and your daily activities (typically 3-7 days). 

STEP 2

After getting the patient numb, the second step of the process begins.  Many people have heard the term, “Smartlipo”, or “laser lipo”, which is essentially the utilization of a laser to melt the fat in the  problematic areas being addressed.  Utilization of the laser also decreases swelling, bruising, and also helps to speed recovery.  This is especially true when compared to the old way that liposuction has traditionally been performed. The micro-laser is so tiny that it can contour small areas that were more difficult to treat in the past, such as upper arms and under the chin. This technique smoothes out the work done with the power-assisted micro cannulas and stimulates collagen formation which can help the skin tighten, producing a smooth final appearance to the treated areas.

STEP 3

After the fat is melted, then the fun part begins.  Meaning, all of the melted fat is then gently  removed  by a very small suction tube.  This is where inches are lost, and new waistlines are formed.  The majority of the time during the procedure is spent on this stage.

Fat abdomen

 Am I A Candidate?

Most importantly, you must be in good health. Ideally, not having any active diseases or significant pre-existing medical conditions is best. 

Make sure you  have realistic expectations of the outcome of liposuction. Open communication is absolutely imperative! You have to clearly understand what your desired results are and be able to convey  this information to your surgeon.  Then, discussion of your goals with your surgeon to determine what can feasibly be done to reach all or part of this goal will be essential.

Further, the elasticity of your skin plays a huge role in whether you are a good candidate. You should have good elasticity, so that your skin is able to shrink  back to its former tightness once the fat is removed. As we get older, have babies, and yo-yo diet, our skin loses its elastic property.  Think of it this way:  if you took a brand new pair of underwear out of the package and stretched out the elastic waistband for 2 hours, then let it go, it wouldn’t snap back to the way it was when you took it out of the package brand new, would it?  Our skin is much the same.  In addition regarding your skin, if you had a 10 pound sack of potatoes and you took out 8 pounds, you’d have quite a lot of sack left over, right?  Obviously, we want that sack to shrink up. Analogously, when you take a large amount of fat out of an area, you’ll have the tendency to have extra skin.  This is where using the laser comes into play. Utilizing the laser (remember stage 2 of the procedure) optimizes the chances that this will happen.  However, the overwhelming factor of whether or not this skin will shrink back  is by far and away your genetics.  How we picked our parents plays a huge roll in this life!  The presence of stretch marks is a flashing neon sign that your skin is not what it used to be, and may not shrink up as tight as it would have when you were 18.  However, many patients really just desire to look better in clothes.  Having extra skin after removal of fat will not effect this.  Again, discussion of realistic expectations between you and your surgeon is a must!

To have that discussion at no charge to you, call 918-786-7780 today!!  We can help and Cosmetic appointments are complimentary!!

Varicose Veins....an ugly term for an ugly and troublesome condition.  Almost everyone remembers a relative that had or has hideous looking legs.  When they show them, the kids run for the hills.  Today, I would like to discuss why the problem occurs and what can be done about it.  Also, a little history to show you how things have changed.....they are a whole lot better today!!

Varicose veins are a wastebasket term for chronic venous insufficiency.  Both are big descriptions for a complex problem.  The issue can range in severity from small spider veins, which most people have a smattering of, to the big ropey veins, to swelling in the lower legs, skin color changes and even leg ulcers that won't heal.

  A picture of spider veins.

  Picture of large varicose vein.

To be nice, I won't show an ulcer, they are ugly!!

The cause of these problems are usually hereditary, but can occur from leg injuries, clotting in the legs, and other factors.  They are made worse by working conditions, pregnancy, but usually not caused by them.  Of course, the human vascular system starts with the heart.  It pumps blood rich in oxygen to the rest of the body.  The blood travels around and exchanges oxygen for CO2 (the byproduct of the cells working), it then must get back to the lungs for the exchange of CO2 for new oxygen and the process repeats.  The veins don't have the heart to pump the blood, so, the musculature of the extremities compress the veins and make the blood move towards the chest and lungs.  In the normally functioning vein, there are valves present that allow the blood to only go towards the chest....up....against gravity that wants it to go down.  In the diseased vein, these valves don't work and the blood pools and stays in the leg or arm.  These pictures are a good visual for how this works.

If the valves do not work properly, pressure builds.  This is reflected in the branches of the larger veins and they enlarge over time creating the large varicose veins we have all seen.  These become painful as they stretch the surrounding connective tissue and the pressure, combined with the lack of flow causes the iron from the blood to break down in the skin.  This can lead to rust colored changes in the skin, rashes, and eventually skin breakdown. 

Treating this problem has changed significantly in the last decade or so.  Since the problem is usually the saphenous vein (kind of an intermediate vein in the leg), we used to remove it surgically and called it stripping.  Many have heard horror stories about removing these veins, having general anesthesia and the recovery time required.  With modern ultrasound and laser technology we can now remove this vein from the circulation without stripping, without general anesthesia, and without a long recovery time......great news!!  We do them in the office, patients walk, in then walk out. There is almost no down time...if any.

For the large, tortuous, ugly branches, we remove them through tiny incisions, as small as the end of a pen.  Because we have stopped the flow into this vein by lasering the saphenous vein there is very little blood loss and again, almost no down time.  The little incisions heal nicely and are not noticed after a few months.

Most of the time, if you are having symptoms of pain, swelling, skin color changes and have a visible varicose vein, insurance will pay for the procedure...after jumping through a few hoops.  Spider veins are considered cosmetic and are not covered though we can treat them with injections or laser.

So if you have vein issues, come see us today at Total Body Surgical where we can help.  Our goal is to try to make your legs look and feel as normal as possible. Call 918-786-7780 today!!

Mommy Makeover.....what's that??  Well, the definition changes for different parts of the country, but here in Oklahoma it usually means a breast lift (with or without augmentation) and a tummy tuck (with or without liposuction).

As most women know, after having children, the ole body has a tendency to change a bit.  The hormones of pregnancy cause skin to stretch and in many cases, it never returns to the pre pregnancy tightness.  The connective tissue under the skin also stretches, leading to the end of that flat tummy.  We all see the movie stars that have babies and shortly after...LOOK GREAT!!  Unfortunately, most of us have to work for a living and cannot spend our days at the gym or in a spa pampering our skin and re-toning our musculature.  Even if we could do that, in many cases, our genetics make it impossible to shake the effects...in many ways, it's the luck of the draw.

To get back on point, after babies and breast feeding, the breast, which enlarged during milk production, shrinks and in many cases sags.  The nipple position that used to be perky now points in a more Southern position and can lose volume.

Here is a picture that shows the different degrees of ptosis or droop.  A or "normal" is perky, high and tight.  After children, all bets are off as to where you will end up.  My experience is that if you start off with little or no breast tissue, the post pregnancy changes are less dramatic than if you start off with a large amount of breast tissue.

Other issues can also occur with shape and in some instances breast abnormalities that have been present since birth.  As you can see in the pictures below, chest wall shape, breast size, breast development, and nipple shape can all play a roll.

With all of this in mind, we try to help you return to your pre-pregnancy state if possible.  This may or may not include implants, but what it does do is re-position the nipple and lift the breast tissue that is hanging.  Some of this tissue may get removed if it is well below the fold where the breast hangs over the chest wall.  My personal experience is that most women desire implants to increase the fullness in the upper pole of the breast.  The incisions can differ depending on how far the nipple needs to move but usually they are in the form of an anchor or "lolly pop".  The nipple is not "removed", it is rotated into its new spot conserving the nervous innervation and blood supply.  These incisions have a tendency to heal very well and after 6-12 months they turn into little white lines.  Implants, saline or silicone, are placed through the same incisions and usually under the muscle so they stay in place over time.

Now for the tummy.....   We see stretch marks, sagging skin, bad c. section scars, bulging, hernias...you name it.  The way to remedy all of these things is with the tummy tuck.

A tummy tuck is done through an incision in the lower abdomen a few centimeters above the labia.  The incision goes from hip bone to hip bone and also around the stalk of the belly button.  The skin is raised off of the underlying connective tissue and muscle up to the ribs.  Once this is done, the loose muscle and underlying connective tissue is tightened back up to make the abdomen flat.  The skin is then pulled down and the extra is removed.  A new opening for the belly button is created.  The smooth, non stretch marked skin from above the belly button is pulled down and stretch marked tissue, scars, etc. are removed.  The incisions are closed and within 6-12 months they become thin white lines.  Some can get away with a mini tummy tuck which removes a small amount of sagging skin (below the belly button) only.

Liposuction can be added to either procedure to remove problem areas in the hips, under the arms, thighs and saddle bags.

The great thing is this.....at Total Body Surgical, we can do both procedures at the same time, saving time and money.....one anesthetic, one recovery time.  How can we do this??  Because we have two fellowship trained Cosmetic Surgeons that work very well together.  We can do both procedures in under three hours and usually as an out patient.

Get your pre baby body back....come see us today!!

Call 918-786-7780 for a complimentary consultation!

We have special spring pricing to help you get back in shape for summer!

Hey everyone!!  Hope ya'll are avoiding the flu bug...bad deal!  People are dropping like flies around here.  The epidemic should be over in a couple of weeks and we'll all be feeling better.  In the mean time, drink plenty of liquids and keep the tylenol handy.

What I want to talk about today is the other epidemic we face in Oklahoma, and essentially the entire country....obesity.  As most of you know, we are in the process of becoming a center of excellence for bariatric surgery.  The new guidelines are out for review and if accepted in the current state, we should be there this year.  What that means is, we will be able to accept Medicare, Soonercare, and most other insurances.  This is good news.  Our goal is to provide quality care locally, big city care with a small town twist.  We are also committed to giving great value, the best pricing around.

We are in the process of doing seminars in multiple towns in the area.  The schedule has been set, but not finalized.  The first one was in Grove this past week and it was a great success.  They last about an hour and cover weight loss surgery, post weight loss cosmetic surgery, and a little about veins.  It's a great opportunity for us to meet you and for you to see what we are about.  It also gives you the chance to start the ball rolling to the new you.  With the lap band, or the gastric sleeve, you can expect to lose a substantial amount of weight and in doing so, correct many of the problems associated with that weight.....hypertension, type II diabetes, joint breakdown, sleep apnea, cholesterol issues, and others.  For those with insurance, we can start the process for you at the seminar (in fact, the seminar is usually a requirement).  For those without insurance, we are working up something special to give you the best price available anywhere.  This will be a limited offer so if you need help, or know someone who does, keep and eye out here...you don't want to miss it.  Of course our current lap band offer still stands and is a great one.

The communities we will be coming to soon are, Vinita, Pryor, Tallequah, Joplin, Miami, Grove, Claremore, to name a few.

We look forward to meeting you and helping you get on track.  Of course you can call for an appointment at any time....918-786-7780

Breast augmentation....is it too early to get ready for summer 2013???  NOOOOOOOOO!!!  In fact, now is the perfect time.

For most women, the surgery is only the beginning.  It usually takes about 2-3 months for implants to settle and skin to stretch to accomidate the implants.  Why??  Well, let's get into that.

  This young lady is a good example to discuss.  For women who have never had children have tighter skin than those who have not...in most cases.  This makes sense in that their breasts have not enlarged gradually over nine months, then shrunk down after.  When the skin is tight and implants are placed, it takes a little bit of time for the skin to stretch to accomidate them, in some cases, up to three months or so.  The other thing to consider is the distance between the nipple and the fold under the breast.  If you look at this picture, in the 45 degree view, you can see the natural fold under the breast that delineates the breast from the chest wall.  This is the nipple to fold distance.  In women with small breasts, who have not had children, this distance is usually very short.  If you can imagine placing an implant in this breast, the implant will ride high until this skin stretches to accomidate the new and extra thickness of the implant.  After the skin stretches, the implant drops into place giving the more natural look that most women want.

As you can see in this picture, the nipple to fold distance in the first photo is essentially non-existant, in the after photo, 3 months later, the implant has settled, the skin has stretched, giving a nice result.  Again, 3 months later!!

For women who have had children, AND those who have not, when we put implants in below the muscle (the more popular way to place them to decrease creasing and rippling of the implant and skin) the muscle does not like to stretch.  Think about it, when you stretch your muscles, it can be uncomfortable until you put the muscle back into the resting position.  The pectoral muscle is no different.  It contracts in an attempt to resume its resting position as well.  This contraction pulls the implant up on the chest wall making it ride high.  It also takes time for the muscle to stretch and allow the implant to drop.  It seems that the bigger the muscle, the longer the implants lose this battle.  We use massage and a velcro strap to help the process proceed quicker, but it still takes time.

Implants can only be placed one way....through the skin.  Whether they are placed through the arm pit, below the breast, through the nipple, through the belly button, or through a tummy tuck incision, there is still an incision.  For saline implants, about 2 cm (less than an inch) and for silicone, 4 cm (a little less than 2 inches).  It takes a little time for these small incisions to heal.  When summer arrives, with enough time, they are barely noticed.  Not enough time, they can be seen. 

It is now January.  At Total Body Surgical, we always have great pricing on breast augmentation, AND the pricing is all inclusive.  This means that the price includes anesthesia, implants, physician, and facility fees.  The only other costs are for medications, and for the post operative bra that is needed...about one hundred dollars.  If you've been thinking about it, NOW is the time to proceed.  You will look great by March, before the summer outfits are even coming out of the closet.  The implants will have settled, incisions will have healed, and you'll be ready for summer fun.

Come in today or call for an appointment 918-786-7780.  Operating time is filling up quickly so act today!!

“Please help me.  I’ve tried every diet out there.  I exercise.  I just can’t get rid of my weight, and it’s literally killing me.”  These are the words I hear all too often in my clinic here at Green Country Bariatrics in Grove, OK.  You see, obesity has become a problem in our United States, and it’s not going away- not even close.  In fact, recent studies of the population show obesity increasing exponentially throughout the world with the USA leading the way.  More specifically, Oklahoma is ranked 7^th, with Missouri close behind at 11^th.  It is truly a staggering statistic to consider  that 30% of our nation is now considered obese.

Why am I overweight?

What is the reason that I continue to be unable to get rid of my excess weight?  Unfortunately, this is not an easy question to answer in a simple way.  Multiple reasons and theories abound, though most likely, it is a combination of more than one of the following explanations:

1. Psychological

Certainly, overeating can be a reason why you’re overweight.  However,
let’s be honest: eating makes us feel good, right? Many eat not just because they are hungry, but rather a result of feeling lonely, bored, or depressed.

2. Anti-Depressants and Other Medications
Did you know that weight gain is a somewhat common side effect of many antidepressant medications?   By slowing down your metabolism or increasing your appetite, they make you gain weight.  Other common medications that cause weight gain in some form or another are Beta blockers and anti inflammatory steroids (corticosteroids).

3. Sleep Deprivation
Look, we all know that we are living in a busy world.   Fitiing in a normal life around work, kids, and various other responsibilities can be difficult.  Did you know that 63% of Americans feel that their night’s sleep is not meeding their daily energy needs?  Scientific studies prove that people who sleep less than eight hours a day gain more body fat that those who sleep more. Why?
Sleep deprivation causes the hormones that control our hunger to get out of control.  What else do you do during the day when you feel sluggish and tired? Yes, that’s correct. You guessed it: we grab that high calorie soft drink, candy bar, or whatever catches our eye in the vending machine to give us a “pick me up”.

4. Slow down!
Did you know that the part of our brain that helps to govern our hunger (the hypothalamus) shuts down after 25 minutes into a meal?  Slow down.  Chew your food.  You’ll find that you won’t consume quite as much.

5. How we picked our parents
Your genes may be causing you to have trouble fitting into your jeans.  According to research, metabolic rate and where your fat is deposited on your body has been linked to genetic inheritance.  Are one or more of your parents heavy? If so, you’ll have a higher risk of gaining and retaining weight.

What do I do?

Fortunately, we live in a day and age of new techniques and  technology to help those with weight issues resolve them.   Did you know that 98% of people who lose weight through diet and exercise alone eventually regain their weight? I have seen countless people at their wits end and frustrated, suddenly find hope.  There IS a light at the end of the tunnel!   Our main focus at Green Country Bariatrics is on YOU.  That being said, our way of getting there is surgery.  We specialize specifically in adjustable gastric bands (lap bands) and gastric  sleeves.  What if I told you that I could help you lose 70-80% of your excess weight?  What if I told you that I could give you a >50% chance that we could cure your diabetes and get you off of your blood pressure meds?  That’s EXACTLY what we offer at Green Country Bariatrics.

Tell me more!

Lap Band: This is a fully adjustable collar that is placed around the top of your stomach.  In a nutshell, it causes you to eat less, and makes you feel fuller, faster.  It is nonpermanent, and is usually done on an outpatient basis.  Occasionally, a patient will need to stay overnight due to their insurance mandate.  A patient will visit our clinic to tighten or loosen the band when needed. A 50% maximum excess weight loss is often seen. Return to work is usually within a week.

Gastric Sleeve: This is an operation that removes 80% of your stomach.  In doing so, we remove the part of the stomach that houses the hormones that cause you to feel hungry.  In addition, we are removing the part of the stomach where you store your food.   It should be noted that it is much safer and quicker than the traditional gastric bypass.  Many of the complications often seen with the traditional gastric bypass (ulcers, internal hernias, dumping syndrome, etc) are NOT seen with the gastric sleeve.  In addition, the anatomy is not rearranged as it is in the gastric bypass or mini gastric bypass.  However, the weight loss is very similar with both giving approximately a 70-80% excess weight loss.  All the perks, but fewer of the hassles!  It is a permanent procedure, and will require 1-2 nights in the hospital.  Return to work is often within 2 weeks.  Many insurances now cover this procedure.

Green Country Bariatrics

We are here for YOU.  We want to tailor your weightloss surgery to fit your needs and personality.  Certainly, we here at Green Country Bariatrics understand your challenges with weight, and want to provide whatever support we can in order to help you accomplish these goals.  Please note that in treating our patients, we want to see you reach your maximum weightloss potential and keep it off!  In doing so, we help you get started with our nutritionist to teach you how to eat, and make better food choices.  We also encourage participation in a support group for camaraderie, accountability, and just being around others who have been through the process.  A contact with a trainer in your area for post surgical exercise can also be arranged.  Lastly, in beginning the new you, many of our patients desire to have reconstructive surgery to lift and remove excess skin after the wight has been lost.  This is completely optional, but we find that the majority of our patients opt for this to complete the transformation process. All of our surgeons at Green Country Bariatrics are fellowship trained in this particular type of reconstructive surgery.

Latest news coverage for Total Body Surgical and Green Country Bariatrics from Joplin, Mo.,.....check it out....
http://www.koamtv.com/story/20349961/integris-grove-fights-back-against-obesity-with-help-of-new-surgeon

Vaginal Rejuvenation....well, don't expect a lot of pictures for this one folks!!  A very touchy subject to be sure.  I'll try to get through this without offending anyone, here goes.

Why vaginal rejuvenation?  The simple fact is, the vagina does a lot of hard work during pregnancy and delivery.  The tissues in the vaginal wall, the labia, the cervix all stretch to incredible size to allow the infant access to the outside world.  The aftermath can leave changes that do not resolve.  For men, imagine trying to stretch your lips around a watermelon then returning to normal....impossible right?  My point exactly.  The vagina and labia undero chronic changes and never return to the pre partum state.

What changes occur?  The outer appearance changes that occur are numerous, but the biggest ones that most women notice are a thinning of the mons area with a loss of fat in the mons and labia majora.  Secondly the labia minora becomes effaced (thinner) and become stretched and longer.  In some cases the labia minora may protrude beyond the labia majora.  The third change that most women notice is a change in the coloration of the labia majora.  It can become much darker, losing its original pinkish hue and becoming brown or in some cases almost black.

The inner changes that can occur are also many and can be complex.  As the infant travels down the vagina, it stretches to a very large size.  Hormones cause the tissue to become very elastic to allow this to occur, however, damage may be done, especially when large babies deliver.  One of the common internal changes that occurs is the enlarging of the vaginal diameter.  This can have long term effects when it comes to sexual satisfaction for both the woman and her partner.  Other things that can happen that are a little more severe and beyond the scope of Cosmetic Surgery are cystoceles and rectoceles.  Cystocele occurs when the connective tissue of the front of the vagina tears and allows the bladder to fall into the vagina.  This can cause difficulty in holding the urine and also cause an unsightly bulging to the front of the vagina.  Rectocele is when the same thing happens in the back wall of the vagina and the rectum bulges in.  These problems can occur simultaneously and may require a surgical procedure to fix, if they are bad enough.  The common problem we deal with is just trying to tighten the vagina after it has dilated, recovered from delivery, but just not to the pre delivery state.

How does this effect Cosmetic appearance??  Well, I'd show you some pictures, but for the sake of modesty, I'll pass.  With newer summer fashions, swim wear, tighter shorts and pants, in many cases the changes can be seen under clothing.  Also, many women are self conscious and are embarassed when naked with their partner, not to mention the decrease in sexual satisfaction.

What does this have to do with Cosmetic Surgery??  Our goal at Total Body Surgical is to take care of all of the Cosmetic needs of our patients and this is a Cosmetic need.  What we do to fix the problem is using one or two procedures.  They can be used individually or in combination.  The first is the labiaplasty.  What this involves is removing the extra and discolored labia.  Labiaplasty leads to a more pleasing appearance to the external genitalia and can also help with the appearance in clothing.  This is a quick procedure with very little down time and in many women, it can be done in the office with some IV sedation.  Healing in this area is very quick and there is only minimal discomfort.  Added to this, to address the thinning of the Mons area, we will often do some fat grafting in the area to make the outer appearance of the mons and labia majora look more youthful...it can make a huge difference.  Second is addressing vaginal laxity.  How do you deal with this??  We make a very small incision at the base of the back of the vagina and insert a laser fiber.  The laser energy causes the vagina to tighten over the next few weeks.  We also tighten the entroitus a little and close the skin.  All of these procedures can be combined and can be done in the office for select patients.  Others, can be put to sleep in the Operating room if that is desired.

What you have when finished is very much like what we see in a face lift.  No fundamental change in the anatomy, just the appearance you had before age and children altered it.  Also, an improvement in the vaginal function.

We recommend that the procedure ONLY be done after having ALL of your children!  It is also a procedure that can be combined with other GYN surgeries, like tubal ligation or hysterectomy.

Come see us today and we'll talk about it....918-786-7780.

Click on the buttons to see our special offers!

Acne can be a terrible affliction or a very minor problem.  It can occur from the teenage years, and also as an adult.  Acne can cause problems that will be present for life, leaving cosmetic issues that may be very hard to deal with.  I want to discuss today the process of the problem and how to handle it.

First of all, what is the process behind the problem???  Acne usually starts in adolesence.  It is a familial problem that manifests during hormonal changes.  It can occur in all skin types and with different degrees of severity.    Acne can lead to social problems that may last a lifetime.  Hormonal increases in adolecense lead to changes in the output of oil in our skin, making it thicker.  This leads to the pores becoming closed, and with bacteria in the skin using this "food" source, they multiply.  The result is the inflamed cystic "comedones" that we call acne. In most instances, the blemishes are limited, resolve in a short period of time, are not severe, and, with the exception of slight embarassment, do no long term harm.  In a minority of cases, the problem is severe, unremitting, and can lead to permanent skin changes.  The changes that can occur are scarring, changes in skin pigmentation, and the resulting self confidence issues that remain. 

What can be done about all of this then?  Most manage by keeping the skin clean and using over the counter products that we see on television.  For minor cases, this is enough.  For more severe cases, these products are no match and the blemishes continue.  At this point, hopefully, parents recognize the severity of the problem and will seek other help.  That is where we can help. 

The first step usually recommend is a change in basic skin care.  We like cleansers that contain salicylic acid.  The salicylic acid in the cleanser helps to liquify and remove the oil that is the root of the problem.  We also recommend benzoyl peroxide solutions that will help reduce the bacterial load.  The third thing I like for patients to do is start a retinol topical cream.  Retinol also helps reduce oil, dry the skin, and compact the stratum corneum, the dead layer of skin cells.  If need be, I will also start an oral antibiotic to decrease the bacteria and decrease the inflammatory response that the bacteria cause.  Antibiotics are generally continued at a low dose as the inflammatory response is less while on them.

For most, these routines are effective in managing the acne.  In others, these steps may not be enough.  The next step I usually add is laser therapy.  We use the Cutera system on a setting that will heat up the skin and kill the actively reproducing bacteria.  There is no recovery time and these treatments can be repeated at 4-6 week intervals with no pain. 

After this step, if no response is noticed, we have a decision to make.  In some women we will add some other medications as hormone modulators such as birth control pills or spironolactone.  If these do not give us results, we then must consider more powerful oral medications.  The one that is the most effective is Accutane.  Accutane is a medication that works very well.  It is also capable of causing problems for some patients.  Everyone has heard of a horror story related to Accutane but few hear of the great number of successes.  The biggest problem a patient can encounter is conception while on the medication.   I-pledge is a program that was instituted to educate patients taking the drug about how to avoid pregnancy and the birth defects that can occur.  Secondly, headaches, brain swelling, depression to name a few are the other side effects than may be encountered while on  Accutane.  The biggest complaints I see are that of dry skin and cracked lips and these are very tolerable.  In most instances the results far exceed expectations and over shadow the risks.  The usual patient takes the medication for 6 months.

My personal philosopy is that the risks of Accutane, when given correctly, are very much worth it.  I am often asked to try to treat patients with scarring and pigment changes resulting from severe cystic acne....this is VERY hard work and is usually only marginally successful.  For that reason, I start off with the less problematic treatments and give them a fairly short trial...6-8 weeks.  If there is no measurable result and the acne is severe, I usually will then suggest Accutane if the patient is a reliable person and can understand the risks.

Come see us today at Total Body Surgical Cosmetic Surgery if you need help....918-786-7780.

What does Christmas have to do with Cosmetic Surgery??? Well let's talk about it. 

Christmas is rapidly approaching believe it or not, it is only a few weeks away.  Now is the time to start thinking about gifts and what can be done for the new year.  Many don't think about anything Cosmetic, but let me help you change your mind.  Instead of that sweater, tie, or other gift that will be worn on Christmas day and then never seen again, how about giving something that can be seen every day!! There are a number of things that are affordable and can make you or your loved ones look and feel better.....much more useful than a sweater!!

First:  Laser hair removal.  We have pricing on laser hair removal that are the best in the country.  If you have young ladies in your life, this is a great gift.  At $50 per area per treatment you can give the gift that keeps on giving for about $300 per area.  No more razors, always ready for summer wear...what a gift.  For guys, we must bring this up carefully but if you listen well, the opening usually comes up so pay attention.  We can remove hair on the face, bikini area, and under the arms on women and for men, chest and back hair removal is all the rage.  Call the office at 918-786-7780 and we can get you a nice gift certificate to put under the tree!

Second:  Botox or dermal fillers.  Everyone has heard of Botox and many of us use it regularly.  It is a great help in reducing wrinkles in the face, stopping excessive sweating, and relieving headaches.  In many cases our loved ones are already using it so why not pre buy and save some money!!  We have special pricing on pre-bought Botox at $9 per unit.  If you figure the average number of units at 30, that is $270 per treatment....very affordable.  The treatments take about twenty minutes and last up to 6 months.  You can take care of his or her whole year with one gift certificate.  Dermal fillers like Radiesse or Juvederm can also be pre purchased at a special price.  These are used to fill nasolabial folds (the wrinkles between the base of the nose and the mouth) and marionette lines (wrinkles from the side of the mouth).  They last about a year.  We also do the so called liquid face lift that fills the cheek area getting rid of lines under the eyes and in the cheek.  This is very rejeuvenating and less traumatic than the real thing.  We are offering a syringe of filler for $400 (usual price $500) and if you purchase more we will lower the price on multiple syringes.  Either of these gifts will get you big kisses.  Call us at 918-786-7780 and we will get you a nice certificate.

Third:  Venous sclerotherapy.  This is the time to get rid of those ugly spider veins before we are back in shorts.  These treatments are done in the office and are fairly quick.  Normally we charge $350 per session but for Christmas, we will lower that price to $300.  What a nice gift to give....getting your legs back, being able to wear shorts again without embarassment.  For a nice gift certificate, call 918-786-7780.

Fourth:  Liposuction.  This can be a little more of a touchy subject but if your significant other is continually complaining about belly fat, saddle bags, love handles, muffin top, fat arms, any other area or combination of areas, they are asking for liposuction but don't know how to say it.  Smaller areas are perfect for liposuction with short recovery time and amazing results.  We have all the specialized equipment too.  Laser liposuction is amazing at helping tighten up the skin after removing the fat.  We will give you a 10% discount on the first area and a 20% discount on a second area.  That is up to a 30% discount on two areas of liposuction.  That means that you can give a gift that will change those complaints into complements.

Fifth:  Breast augmentation.  College students, wives, and girlfriends are always talking about having breast implants to improve self image by improving appearance.  What better gift to give.  We have the best pricing on silicone and saline implants right here in Grove.  Christmas is a great time to schedule and take advantage of the winter to heal up and be ready for summer. 

There you have it...some great ideas for Christmas gift that I guarantee will be appreciated.  Dr Miller and I or our nurses are also ready to help if you have questions about what is appropriate.  Call us today at 918-786-7780 and GET YOUR SHOPPING DONE early for once!!!!

Winter time is vein time a wise man once said (that's me ya'll)!!

Why is winter time the time to worry about those pesky leg veins??  Well, it's because you are already wearing pants.  In spring and summer we want to wear shorts, or other more revealing clothing, it is then too late to conseal any ongoing treatment.  In winter, the healing process can take place under your clothing and people won't ask too many questions.  Now is the time to treat spider veins and larger varicose veins.

Spider veins are small areas that most of us get as we age.  These are pesky and ugly but usually do not indicate any major underlying problem with the larger venous system, although they can be an indicator.  They look like the skinny legs of a spider, thus the name.  They can also look like a bruised area that doesn't go away.  Spider veins progress with time and can be made worse by certain occupations..standing, etc.  They usually cause little concern except for their ugly appearance, however, they can become large enough to bleed if traumatized and an episode like this can be very frightening. 

What do we do for spider veins??  The best way to handle them is with sclerotherapy.  Now that may sound scary but really it is pretty simple.  We inject the veins with a chemical that causes them to stop working.  Sometimes a small clot forms in them and over time, your body resorbs the clot and vein eliminating the problem.  The process is fairly easy, quick, and causes minimal pain.  We have you wear a tight (compression) stocking for about two weeks after the injections and after that....nothing.  You may have some areas of pigmentation in the area for a few months and this usually resolves without further treatment.  Because this problem is superficial, most insurances consider this treatment Cosmetic and will not cover it under the usual policy.  We charge $350 per treatment and a treatment consists of two vials of the solution we use which is the safe amount at one sitting.  If more treatments are required, we usually wait about 6 weeks before re-treating.  Small areas usually require only one session.  Big, or multiple areas may require several sessions.

For a little larger veins we call reticular veins, we still use the sclerosing solution.  Sometimes it is used in a higher concentration and we use an instrument called a vein light. 

The vein lite allows me to see the larger veins under the skin that fill the small spider veins on the surface.  This instrument produces a very bright, circular light that produces no heat and is very good at showing reticular veins as you can see from the picture above.  I can then inject them with the sclorosing solution, stop the blood flow, and with time, the vein is eliminated by the body.  I usually try to find and eliminate any of these veins at the time I do the routine sclerotherapy.  Again, stockings should be worn for two weeks after the therapy and strenuous exercise is avoided for two weeks as well.  This helps in preventing future spider veins originating from this one source at least.  

Maintenance may be required when treating spider veins.  They usually sneak back into your life after a few years, even if all of them are eradicated along with the reticular veins.  I like to recommend that less is more....in other words, if we treat a large amount the first series of treatments, it is a lot easier to keep up by treating small areas as they arise.  Don't let them get out of hand again. 

More about varicose veins next time.  Don't forget our special pricing and come meet Dr. Miller, he knows veins too!!!