Total Body Surgical Blog

What's the point???  Well, there are several.  This week I would like to summarize the past several weeks.  As obesity becomes a growing world wide problem, obesity surgery is becoming a common thing.  The common procedures are the Lap Band, the gastric sleeve, and the Roux en Y bypass.  They all have their place in the treatment of obesity.  As the procedures and massive weight loss occur, the desire and need for body contouring increase.  If you did not see the previous installments, go check them out to see what procedures are most common and in greater detail.  This installment will cover some of the high points of more detailed discussions of weeks past.

1.  Your weight should be stable for a minimum of 12 months.  Lose the weight, get where you want to be and stay there for at least 12 months before having surgery.  Doing it this way gives better results and leads to fewer repeats.

2.  You must be healthy.  Cosmetic surgery is not "minor" surgery.  People can have complications and even death from this type of surgery.  Make sure you have a healthy heart, lungs, kidneys, and that diabetes and hypertension are controlled prior to your surgery.

3.  You cannot have it all done at once.  These surgeries can be very taxing on the surgeon and you.  Sit down and figure out, in order, what bothers you the most.  Then discuss with your surgeon a strategy to attack the areas in a planned way that makes sense and is safe.  Sometimes procedures can be combined but don't get in too big of a hurry, be safe.

4.  Know what is available.  The most common procedures I see, in order, are:

-Tummy tuck

-Breast lift

-Arm reduction

-Butt lift

-Face lift

-Thigh lift

-Back lift

5.  Seek out a safe and well trained professional....nuff said.

Hope this helps.  New topic next week.  If there is anything you would like to hear about, drop me a line, jeffswetnam@yahoo.com and I will try to address it.

Thanks for tuning in and don't miss our specials.  New ones coming for the fall to so keep looking here.

For the last installment on massive weight loss, we will look at the face. Massive weight gain can cause unrecognizable changes in the face.  The neck, cheeks, and chin become stretched with fatty deposits and cause skin changes that may be permanent even after weight loss.

For the lucky few, facial skin will shrink back to its near normal state.  In these cases, nothing is needed.  For the most part, however, what we see is skin that sags in the neck area and jowl formation in the lower face.  Wrinkles may also appear in the cheek area and in the mid face we see volume loss that creates that "tired" look.  In people that lose massive amounts of weight, these changes can occur regardless of age.  When weight loss patients present, they usually have numerous areas of concern and I try to help them prioritize because we cannot do all procedures at once.  Some want their face fixed first, some don't, again, it is a matter of priority.

The only way to gain long term results in recovering a youthful face are lifting procedures.  We devide the face into three main areas. 1. The lower face and neck. 2. The mid face. 3. The brow.  A fourth area would be the eyelid that I will talk about in a later blog.  

The lower face and neck lift.  This procedure addresses the excess neck skin, jowling, and wrinkling in the cheek area.  Sagging skin in these areas can be very pronounced after massive weight loss.  Incisions for this procedure are placed around the ear   and a small incision under the chin.  The arrows show the direction of pull on the skin and the underlying muscle.  If the neck is not lax, a mini face lift (s-lift, lifestyle lift, day lift, etc.) can be done which shortens the incision to the front of the ear and only partially up the back of the ear.

The brow, when sagging, can cause visual problems and most notably can cause wrinkling in the forehead because of continuous muscle contraction as your brain lifts the brow.  For the most part, I use the endoscopic approach to lifting the brow.  This is done through small incisions in the hair that are essentially invisible.  The brow is lifted and anchored.  After doing this procedure, the forehead becomes smooth and the hooding over the eye is gone.

The face lift and brow lift can be done simultaneously if desired.

For the mid face, the problem is usually loss of volume and a hollow appearance develops.  I feel the best way to remedy this problem is by replacing this volume.  This can be done in several ways.  The shortest lasting way to do this is with a filler product.  The volume is placed over the cheek area.  The second best product is fat.  The fat is harvested from the hip or abdominal area and transplanted back into the face rejuvenating the mid face.  The longest lasting way is with implants.  These are solid silicone, pre-formed devices that replace the lost volume in the area.

These three procedures are the ones most commonly used to treat and rejuvenate the face after weight loss.  Not everyone fits the usual mode however, and consultation to figure out the best treatment for you is essential.  Come see us at INTEGRIS Total Body Surgical for a complimentary cosmetic consultation.

Don't forget our breast and lap band specials that are still going on. Act now to take advantage of great savings!! 

To continue the conversation about body contouring after weight loss surgery, this installment will address the thighs and knees.  After the weight loss, the tummy tuck, the arm reduction, the breast lift, and the butt lift, many people are ready to address the thighs.  You may not need all of these procedures, you may only need one or two.  If more than one procedure is required, I usually save the thighs for last.  Why??  Well, to be honest, it is a difficult recovery because of where the incisions must be placed.  Do you need a thigh lift, or will liposuction cure the problem?  It depends on the amount of extra skin that is present.  Too much sagging skin will not contract with liposuction and will need to be removed.  A problem area of fat depostion can be liposuctioned. 

Incisions for a thigh lift are in the groin, following the contour of the upper thigh.  To lift the knee, the incision travels down the inner thigh, making a kind of "T".  Removing this skin allows us to make the thigh tighter and removing the skin in the groin allows us to pull the skin up getting rid of the sagging and re-shaping the thighs.  The incisions are placed in a high motion area that stays moist and is close to areas that can be difficult to keep clean.  These factors can make wound healing a challenge in the best of circumstances.....thigh lifts are not for the faint of heart.  They can, however, make a huge difference in appearance and wardrobe. 

Come see us at Total Body Surgical for all of your body contouring needs.  Time is running out to take advantage of the Breast and lap band specials so don't miss them!!

More next week.

What about butts after massive weight loss?? 

Many changes occur after weight loss.  We have been discussing arms, abdomen, breast and when to proceed with these procedures after weight loss or weight loss surgery. 

The problem with massive weight loss is that protein stores in the body are consumed after sugar and before fat.  We all want to lose the fat first but this is not generally what happens.  Fat is the bodies way of long term energy storage and is mobilized only after other sources are used up or low.  In massive weight loss, especially after bypass surgery, muscle protein is mobilized as the weight loss proceeds.  One of the biggest muscles in our bodies is the muscles in the butt.....the gluteal muscles.  Think about it....these muscles are the lever that allow us to stand, walk, use stairs, etc., it is not just a seat pad!!  As weight loss proceeds, this muscle gets smaller as protein is mobilized and used for energy.  As this occurs, of course, the skin sags and the butt ends up on the upper thighs.  Many people want their butt back to its original position.  The way we put it back is with the butt lift.  It is similar to a tummy tuck for the rear end.  The incision is placed along the upper Gluteal region and the skin is lifted up to remove the excess.  In some instances an implant can also be placed to give more volume to the butt.  The one pictured here has had a previous tummy tuck as well.

Come see us at Total Body Surgical for all of your after bariatric surgery needs.  Also, don't forget our breast augmentation and Lap Band special pricing....time is running out so ACT NOW!!

I will continue to discuss procedures that are common after weight loss surgery.  The most common is the tummy tuck which was discussed in previous blogs and breasts are probably the second most common area addressed in women. 

The reason breast take such a beating after significant weight loss is that breasts are about 80% fat to begin with.  It follows that when women lose a large amount of weight, what is lost is fat and muscle.  The skin of the breast is "deflated" and what actual breast tissue remains hangs in the deflated skin....Rocks in Socks.

The objective when reconstructing the breast is to reposition the nipple and areola and if desired, refill the breast envelope.  There are options when rebuilding the breast.  One option is to lift the nipple and remove excess skin only.  This choice is certainly acceptable but does not give the fullness in the upper breast many want.  To get this, an implant must be used.  The incisions for reconstruction of this type vary based on the distance the nipple must be moved above the lower fold of the breast.  Usually the incision is an anchor type incision, around the nipple, a vertical and a horizontal incision below.  The nipple is not removed, just moved on a pedicle into its new position.  Breast skin and tissue is removed to reshape the breast.  An implant adds fullness to the upper aspect of the breast.  The implant can be placed at the same time.

Come see us at Total Body Surgical and take advantage of the specials above!!

After weight loss surgery, as we discussed the past few weeks, skin can become loose and not return to its pre-surgical state.  Last week we talked about tummy tucks, removing skin from the abdomen and tightening the underlying muscles.  This recreates the shape and tightness of the abdomen that is lost after weight loss.  Another common procedure that is requested after massive weight loss is the arm reduction or brachioplasty.  Many people gain excessive weight in their arms and after the weight is gone the skin can hang.  Many describe these at "bat wings".  The unsightly nature of this excess skin becomes hard to conceal and makes wearing short sleeves, tank tops, or anything other than a long sleeve top impossible.

What to do about it??  There are some non-invasive ways to tighten up the skin but these are usually inadequate after weight loss.  It requires skin removal, just like with the tummy tuck.  The up side to this procedure is the reclaimation of your original arm shape with the ability to wear more fashionable clothing and the loss of the "bat wings".  The down side, as with most cosmetic procedures is the scar that occurs on the medial aspect of the upper arm. Photos compliments of the ASPS.

Fortunately, this scar is on the inside of the arm and becomes less and less visible with time. 

Come see us at Total Body Surgical where we do ALL post weight loss body contouring.

ALSO, be sure to take advantage of the Lap band introduction at INTEGRIS Total Body Surgical, and the Breast Augmentation Special through the end of July!!

Last week we talked about who is ready for Cosmetic Surgery after weight loss surgery.  If you have not read that installment, read it first.  Today we are talking about one of the most common procedures desired after weight loss and that procedure is the tummy tuck or abdominoplasty.

After massive weight loss, either surgical or diet, many people have excess skin in the upper and lower abdomen.  This is not only unsightly but can cause to infections, rashes, and leads to the problem of where to put it in clothing etc. In a few cases, insurance may even cover the removal, but in most instances, it is considered Cosmetic and remains uncovered.  When covered by insurance, usually only the lower hanging skin is removed and this skin and fat is called a pannus.  The procedure is called a panniculectomy and is meant only to remove the skin that is hanging and prone to infection.  It is not meant to be a cosmetic procedure.

In a true tummy tuck, the entire abdomen is addressed.  The skin in the upper and lower abdomen is addressed and the underlying muscle is tightened.  The idea is to regain the appearance and shape that was lost with weight gain. 

There are two common types of tummy tuck.  The first is the full tummy tuck that is probably the most common.  The incision is across the lower abdomen and around the belly button.  I like to keep the incision as low as possible to conceal it below garments and swimwear.  The belly button stays where God put it but the skin and fat is elevated, pulled down and removed.  Before re-attaching, the muscle is tightened in the middle of the abdomen to flatten the stomach and get rid of any laxity in the connective tissue.  The upper skin is then pulled tight and sewn to the lower skin.  Finally, the belly button stalk is located and a new opening is created in the overlying skin and it is sewn in place.  A plastic tube drain is placed in the space under the skin and it stays in place until this space stops producing fluid....about a week.  During this time I advise patients to stay bent over a little until the skin stretches.  A garment is also worn for several weeks. 

Full Tummy Tuck

For people that already have an incision in the middle of the upper abdomen, an anchor abdominoplasty or Fleur Des lis tummy tuck may be more appropriate.  This can tighten the waist as well.  Here is a video that demonstrates the procedure.

Anchor or Fleur Des Lis tummy tuck

The second most common type of tummy tuck is the lipoabdominoplasty or Avelar abdominoplasty.  In this technique, the fat is removed with liposuction until the skin becomes loose.  The incisions are made in the lower abdomen and around the belly button, the skin is pulled down and removed.  A tunnel is made to allow tightening of the underlying connective tissue and a drain is placed. I could not find a good video for this procedure....guess I need to make one!!

It just depends on your specific needs and wants when choosing a technique.  Many cosmetic and plastic surgeons try to make everyone fit into one procedure.  Find one that can offer choices and be sure to look at before and after pictures AND be sure they are the Doctors work and not someone elses!!

Come see us at Total Body Surgical Cosmetic Surgery to investigate all of the options.  Don't miss out on our special pricing on a number of procedures.  Press the tabs below to see them.

Next week...the arm reduction. Thanks for reading!!

Over the past few weeks (with the exception of Butts last week) we have been talking about weight loss and surgical options.  This week I would like to start the discussion on what to do AFTER losing all the weight.  I guess the first question is....who qualifies to have post bariatric body contouring??  Well, first of all, you must be healthy enough for elective surgery.  This means that your medical conditions, if you have any, should be well controlled. I think it is a fairly well known fact that most insurances will not pay for this type of surgery so I wouldn't expect it.

Hypertension, diabetes, heart disease, renal and others should be stable.  Fortunately, after massive weight loss, many of these problems are cured as the weight falls off.  The second thing that cosmetic surgeons consider is the stability of the patients weight.  My rule of thumb is a stable weight for a minimum of 12 months.  In other words, after weight loss surgery, we usually don't perform any body contouring until the weight loss has stopped and a stable weight has been maintained for a year.  This helps us avoid performing surgery more than once or getting results that are less than expected.  Since most patients are spending their hard earned money for these procedures, this precaution is usually appreciated.  One problem that weight loss patients struggle with is their new body image.  Once the weight starts to fall, the skin, which has been hopelessly stretched, does not return to its normal position and begins to hang.  As this occurs, patients have a tendency to become impatient with the process and want it removed.  It is my job to encourage patience with the process and wait until the weight has stabilized.

The next step is planning.  I like to start with a wish list....what bothers you about your new body sort of thing.  Depending on the amount of weight lost, this can be a very long list.  It also depends on how an individual loses weight.  This can be different for each person.  This is why there is no cook book remedy for everyone and procedures are personalized. 

The procedures that are requested are numerous and will be discussed in coming weeks.  Next week we will start with the most common procedure, the tummy tuck or abdominoplasty.

Today I want to talk about Butts.  Butts used to be maligned and frowned upon.  Things have certainly changed in society today.  After Jennifer Lopez and the Latin boom and the fame of many African American TV and Music stars, Butts are now on the front page.  Many of us were not blessed with a shapely rear compartment, and people that lose considerable weight often lose their shape as well, as muscle is lost.  One way to enlarge the area is to work hard to enlarge the gluteus muscle.  This is often hard to do and may not be possible for some people.  Fortunately, there are other options.

As we age, many of us grow "love handles" or hips.  These cause the butt to lose definition and even if it is present, it becomes concealed.  The first way to increase shapeliness is liposuction.  With liposuction of the love handle or hip area, the butt area gains more definition and appears larger.  For those with an ample hind quarter to begin with, this is all that is necessary.  For people that are still deficient, the Brazilian Butt lift may be the answer.  This procedure is done by augmenting the buttock area with fat grafting.  This is where we liposuction unwanted fat from the love handle area, abdomen, thighs, or anywhere else it is present, process the fat and transplant it into the buttocks.  Amazingly, if there is enough fat to harvest and transplant this is a great and lasting solution.  Of course, as the name portrays, it was developed in Brazil where butts are king.  Studies show that if done properly, it is very effective, and safe.

The problem for some is the lack of fat to harvest.  Some people are thin and have no fat to obtain.  For these people, implants are the solution.  Butt implants have come a long way in the recent past.  They used to be hard and could be difficult to place.  With newer silicone technology they can be made softer with the feeling of real muscle tissue.  They are placed between muscle layers and look and feel very realistic.  They also come in several different sizes to fit nearly anyone.  Recovery time is relatively short and you can go from flat to shapely literally over night.

At INTEGRIS Total Body Surgical, we offer all of these modern solutions to this age old problem.  Liposuction, the Brazilian Butt lift, and implants.  Come see us for a complimentary Cosmetic consultation to see which is the right one for you.

Keep an eye out for liposuction special pricing coming soon.  Friend us on facebook for direct notices on all special offers or on Twitter.

Also don't forget our Breast, Laser hair removal, and Lap Band Specials that are currently running....they are great offers!!!-Incredible Value on the LAP BAND!!!

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Last week I began the discussion on surgical options for obesity.  This week, the topic will remain the same but more In depth.

First, however, I would like to tell you about the AACS approved conference I just attended in California.  The conference was held in the Sacramento area and covered Liposuction, Tummy Tucks,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Butt implants and Augmentation with fat.  I gave lectures on difficult tummy tucks and combining tummy tuck with other surgery.  I also gave a lecture on how to avoid blood clots that can sometimes occur around the time of surgery and lastly I lectured on advanced liposuction techniques.  The course was a roaring success and afterward we all spent the day in Napa Valley trying out some California wines.   The course was attended by physicians from as far away as Viet Nam….pretty cool.  I always learn good stuff at courses too, even if there in a teaching mode and this time was no different.  I learned some new and cool ways to shape butts and make them larger with both fat and implants or both.  I have had a fair amount of experience with these techniques but I learned some new tricks.  Now is the time to hit me up if you need a rear end overhaul!!

Now, back to obesity surgery. 

If you look at statistics for all types of obesity procedures, you will find some interesting facts.  Most of these studies look at the percentage of excess body weight (EBW) lost over a set period of time.  The way EBW is measured is by subtracting maximum weight from Ideal body weight.  This gives us a number that can be measured and compared.  If you compare bypass, sleeve, and lap band procedures, in the short term time frame, the bypass and sleeve appear to work better than the band.  However, even though most people would like to lose their weight quickly, they also know that this may not be the best for them.  The lap band is slower and requires adjustment, not because it loses volume, but because the anatomy changes as we lose weight and the band loosens.  With the bypasses, no adjustments are necessary.  The interesting thing is that the studies looking at EBW at the five year and older mark are nearly the same!  There is only a 2% difference between the lap band and the more invasive procedures when losing weight.  In other words, if you are overweight by 100 pounds and we look at your progress at 5 years, if you have had a bypass you will have lost 58 lbs on average or about 58%.  If you have had a Lap Band, you would have lost on average 56 lbs, you would have just lost it a little slower.  Pretty interesting!!  Many people have knocked the band in the past for not being as successful.  After looking at these numbers, the only difference is 2% at five years, AND your anatomy has not been permanently changed, AND it can be removed if you want it gone, AND your problems with vitamin deficiency, muscle and other protein wasting will not be as severe.  What I am not saying is the lap band is for everyone as clearly it is not.  At Total Body Surgical Cosmetic Surgery, I like use fairly clear parameters for those I think it is best for.  I think it works better when the person has a BMI between 30 and 50, has few or no comorbid conditions.  Larger patients are generally sicker from their weight and need to lose it faster.  With the lap band, you will need supervision, you will need weigh in’s and volume added to the band to help you lose the weight.  You will change your personal dynamic with food. Below is a youtube showing how the procedure is done.

http://youtu.be/KPuThbFMxGg

More next week....

Remember the breast special, the laser hair removal, and vein specials we currently have going!!

http://www.totalbodysurgical.net/breast-aumentationact-now/Default.aspx?utm_campaign=Grand-on-GRAND&utm_source

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