Total Body Surgical Blog

 

 

At INTEGRIS Total Body Surgical Cosmetic Surgery we are a dedicated Lap Band facility.  This means that we have chosen to only offer the lap band for our patients who have failed diets and are at risk for developing complications of obesity.

Obesity in America is at epidemic proportions.  Look at this from the CDC

Literally every state has an issue with people being over weight and in many states.....severely.  All we need do is walk down the street to see how bad it is.  The question is what to do about it??  This question deals with numerous issues that are difficult to quantify.  We are victims of our own prosperity and it is rapidly spreading around the globe.  We now have readily available food.  Our activity levels continue to decline.  The food is processed in ways that may be detrimental to our bodies.  Bad habits are passed on to our children and this is perpetuating the problem.  Obesity is becoming an issue globally.  Many will say "so what", I am fat and hurting nobody, why should you care??  What we see is the rising cost of the care that is required as we get older and fatter.  When people are young, their bodies can compensate for their weight by producing more muscle to haul the excess weight around.  They can produce more insulin so blood sugars don't rise.  Young hearts can beat more efficiently to send oxygen to the excess.  BUT, as we age, our skeleton is not capable of carrying all the excess and begins to fail.  Our pancreas cannot keep up and the fat causes insulin resistance.  Arteries become clogged with fat causing atherosclerosis, starving the heart, losing efficiency.  We then have joint breakdown, hypertension, coronary disease, adult onset (type II Diabetes), and the inability to increase activity.  These chronic problems are an expensive drain on the medical system and it effects all of us.  Not to mention all of the man and woman power we lose as a nation.

Diet and exercise of course is the way to combat the problem in the ideal world, however, this is not always a realistic solution.  Sometimes alternative methods are required.  Medical supervision is the next step using supervised diets and in some instances, medication to curb appetite.  When all of these methods fail, the next step may be a surgical alternative. 

There are many surgical procedures available for weight loss today and I will talk about the main ones briefly.  First of all, who qualifies for weight loss surgery?  Obesity is measured by body mass index or BMI.  Though not perfect, it is a way to measure a persons weight and index it for height giving us a number to use to gauge a persons weight.  To calculate your BMI, use the calculator on this site 

http://www.nhlbisupport.com/bmi/

New FDA guidelines consider a BMI above thirty to be of concern.

They consider a BMI over 40 to be morbidly obese. 

The three most commonly performed surgeries for obesity today are the Roux-en-Y gastric bypass, the gastric sleeve, and the Lap Band.  The Roux-en-Y is a good procedure for those who are very heavy, with diabetes, and need to lose weight quickly.  This bypass is good for more rapid wight loss and is better for controlling blood sugar.  This procedure is both restrictive (making a smaller stomach) and causes some diminished absorption.

The Gastric sleeve also causes more rapid weight loss.  It is restrictive by making the stomach smaller but does not have as many absorption issues.

Both of the larger surgical procedures have a short and long term complication rate.  .19% death rate and a complication rate of between 5 and 10 percent for the gastric sleeve.  For the gastric bypass the death rate is somewhere between .2 and .5 % with complication rates being 10-15% short and long term.  For the lap band, the death rate is .09% and the short and long term complication rate is 1-3%.

Next week we will focus on lap band surgery, how it's done and what you can expect...we'll have video too!!

Remember our Breast and Hair removal offers and get ready for the introductory offer on the Lap band!!!!

Very exciting!!

Breast augmentation special

-Laser HAIR Reduction....buy one area and get one F

      

I hear you....OK....it has been a lot of information on skin...I know.  This will be the last installment on skin, at least for a little while.  I am going to talk a little about skin color changes or dyschromias.  No YouTube this week...couldn't find a good one for ya'll.

What causes dyschromia in our skin??  The same old things...too much sun and poor skin care habits.  Added to these problems are hormone changes, rosacea, venous changes in the skin, skin thinning with age, etc.  All of these problems create the browns and reds that become apparent as time progresses.  The terminology for dark spots are poikiloderma or brown spotting that usually occurs on the chest after years of tanning and melasma or brown discoloration on the cheeks and face in a mask like distribution.  Melasma can occur in younger women during pregnancy and is certainly related to hormonal changes with pregnancy and menopause.  When the sun is added to these changes, it can be dramatic.  We also can get vascular changes in the face.  The most common areas are on the cheeks and around the base of the nose.  Here you may see visible veins, small cherry red spots, even a generalized redness.

After identifying the changes, what can we do about them?

There are many approaches and all of them begin with good basic skin care.  I recommend some type of retinol cream and a topical vitamin C along with this.  To help tame those brown spots I also add hydroquinone to turn off the melanocyte that produces the pigment.  Retinols are vitamin A compounds that help thin the "dead" layer of skin and stimulate growth of new skin.  Over time they make a big difference.  Sun screen is also crucial to help stop the damage.  At Total Body Surgical, we use the Obagi system because they are pharmaceutical grade and make a dramatic difference over time.

After taking care of the basics we can address the color issue with lasers and Intense Pulsed Light or IPL.  The IPL is a flash lamp system with wavelengths that target the pigment we want to get rid of.  The reds are diminished and the browns crust off while turning off the melanocyte.  IPL treatments are usually done in a series of 3 to 5, about a month or so apart to be successful. Vascular lasers are used to treat hemangiomas, visible veins, and larger red spots. These treatments can be combined with milder forms of laser skin resurfacing.  At Total Body Surgical we use Cutera technology.  This system has the Limelight IPL system that is good at treating multiple pigments in the skin.  We also have the Pearl which is mentioned in this segment,

http://youtu.be/0goYcY3LTqQ

The Pearl is a good way to get immediate results with the added benefit of "buffing" the skin.  This creates a new skin feel that is softer, recreating that glow that is age defying.  The treatments can be "stacked" on each other to get the benefits of both.  When used for treating pigment, recovery times are usually no more than 4 days.

Well, that about covers the face.  From facial skin care to face lifting and implants.

We have extended the breast augmentation special pricing through July so don't miss out, -Breast Aumentation....ACT NOW!!!

I am also working on a special Pearl package for the fall (you should not be tanning when we do it) as this is the perfect time to start.

Next week....tackling obesity with the Lap Band!!!

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Watch this video....if it were only that easy to defy gravity!!!

http://youtu.be/iNQ3BHKm57o

For the final installment on wrinkles or rhytids we are going to cover procedures for people that other easier methods will not work for.  We have discussed skin care and sun avoidance for prevention, then Botox to rid ourselves of lines that are not yet permanent.  For areas that Botox will not soften, we use fillers such as Radiesse and Juvederm.  After these products have worn out their ability to improve we move into laser skin resurfacing.  When all of these tools fail....then what?  The answer is the facelift.  Sometimes only a surgical correction will do.  As we lose collagen and fat in our face and the connective tissue below the skin sags, the skin follows and becomes lose.  There are some non-invasive methods that may help, but minimally.  Face lifts come in many different types and one size does not fit all.  The oldest types only address the lose skin and have little longevity, they fail in no time because the skin stretches quickly and wrinkles and loose skin return.  Don't believe that skin stretches quickly???  Talk to a pregnant woman, skin can stretch to an incredible size, and can do it quickly.  Real face lifts address the underlying connective tissue, tightening it, and then remove the excess skin.  There are several types of lifts that are commonly used and the procedure should be individualized for each patient.  The one picked should address the specific areas that need to be lifted.  The mini face lift (s-lift, lifestyle lift, short scar lift, etc.) addresses the lower face, jowel area and some lose skin in the neck.  The vector of pull on the connective tissue and skin is up and toward the ear.  The incision starts at the temporal tuft of hair in front of the ear, follows the front contour of the ear, down around the ear lobe, and a short distance behind the ear.  This lift does have a shorter recovery time and works great for the appropriate patient.  Those with a heavy neck will need a "full lower face and neck lift".  This lift has the same incision but is is extended onto the back of the ear and into the hair line.  The vector of pull for the connective tissue and skin is not only up for the lower face, but is back and up for the neck as well.  Usually there is also a small incision under the chin to remove fat and sometimes tighten or remove some of the underlying muscle tissue.  During face lift surgery, the underlying connective tissue is tightened to correct the loosened structure that causes the face to droop and some of the fat is sculpted or liposuctioned too.  Then the skin is draped and trimmed then carefully sutured into its new location.  Facelift surgery should also address underlying bone and fat deficiencies too.  This may require cheek or chin implants, fat grafting, or other techniques.  A good face lift should not leave the patient looking stretched, it should not disrupt the normal smile or look fake.  The incisions heal very well over time and are difficult to detect.  You should look younger and well rested.  When looking for a face lift surgeon, demand to look at pictures and be sure that areas that bother you will be addressed.  Also, make sure the pictures you look at are from patients done by the surgeon you are talking to...this is an old trick...claim anothers work for your own.

At Total Body Surgical Cosmetic Surgery, Dr Swetnam has experience with numerous lifting techniques and can assist in selecting the one appropriate for you.

Come see us where cosmetic consultations are complimentary!!

Don't forget our Breast augmentation spring special and our Laser Hair Reduction Special too....Hurry though, not much time left!!

-Breast Aumentation....ACT NOW!!!

-Laser HAIR Reduction....buy one area and get one F

-LOVE YOUR LEGS......AGAIN!!!!

Next week, more about skin, brow and mid face!!

This week we are still talking about wrinkles!!  Ya'll will enjoy this one...

http://youtu.be/NCvHgppVey4

To sum things up at this point, young skin, ages up to about 30 just need protection from the sun and some type of vitamin C product to maintain collagen production (Obagi or Skinceuticals make great products).  From ages 30-40 or 50 most can get by with good skin care, and add Botox to slow the musculature down that is causing the typical wrinkles between the eyes, crows feet, and forehead lines.  For stubborn wrinkles that are too deep for Botox, fillers such as Juvederm and Radiesse can be used to soften them.  Laser procedures and peels can help a great deal as well and that is what we will discuss in this installment. 

Lasers have come a long way in the past several years and this is exciting.  Laser technology has come a long way and this seriously benefits our patients. The old complications can still occur but are not as common with fractional techniques.  The most common problems are hyperpigmentation, hypopigmentation, persistant redness, and scarring.  These problems are less likely with the new technologies and pre treatment.

Who needs or wants laser treatment?  There are many indications.  The most prevalent use is for treatment of mild to moderate wrinkling.  It also helps a great deal in rejuvenating the skin and helping remove spots from sun damage.  Lasers stimulate the skin to make more collagen and make it look much healthier by removing damaged stratum corneum (the outer layer) and promoting new skin growth. 

Older "full ablation" laser techniques removed all of the outer layer.  Since the skin heals from either hair follicles or by expanding from undamaged areas, this took awhile.  Newer laser technology allows us to "fractionate" the damage.  This means that we can now regulate the energy put into the skin, the depth of penetration , and the separation of spots that are treated.  In other words, we are treating small areas that are surrounded by normal skin.  This allows the skin to heal much quicker so recovery time is much shorter and complications are less.  The down side is that multiple treatments may be required to get the same result.

At Total Body Surgical, we have the Pearl Laser by Cutera. www.cutera.com  .  We have access to other lasers as well, depending on the need.  This laser is a great tool to treat both younger and older skin.  The recovery time is usually only 4 days.  This means you can begin wearing makeup after four days and look about back to normal in a week or two.

Come see us at Total Body Surgical Cosmetic Surgery for complimentary cosmetic consultations, Obagi Products, or laser therapy.

Don't forget our Breast Augmentation and Laser hair removal specials!!

  Last week on the Total Body Surgical Cosmetic Surgery blog we talked about wrinkles and how good skin care and Botox can make a big difference.  This week we will take a look at the common fillers that can be used.

Below is one of the commonly used scales to measure and quantify the severity of wrinkles and skin damage.

Group	Classification	Typical Age	Description	Skin Characteristics
I	Mild	28-35	No wrinkles	Early Photoaging: mild pigment changes, no keratosis, minimal wrinkles, minimal or no makeup
II	Moderate	35-50	Wrinkles in motion	Early to Moderate Photoaging: Early brown spots visible, keratosis palpable but not visible, parallel smile lines begin to appear, wears some foundation
III	Advanced	50-65	Wrinkles at rest	Advanced Photoaging: Obvious discolorations, visible capillaries (telangiectasias), visible keratosis, wears heavier foundation always
IV	Severe	60-75	Only wrinkles	Severe Photoaging: Yellow-gray skin color, prior skin malignancies, wrinkles throughout - no normal skin, cannot wear makeup because it cakes and cracks

Class II we would usually use Botox or Dysport because slowing the underlying muscles will usually eliminate the wrinkle as long as it is maintained.

Class III wrinkles will usually require "filling" as they are present at rest and are more or less permanent fixtures.  Filling them will not remove the wrinkle 100% but will go a long way toward making them tolerable.

There are many fillers on the market and thank goodness most of them now last a year or more.  This is in contrast to only 5 or 6 years ago when a filler would work for 2-4 months.  Many techniques can be nearly peramanant.

Hyaluronic acid fillers such as Juvederm and Perlane are great all around fillers that can be used nearly anywhere in the body.  This is because it is a naturally occurring substance in the body and is colorless.  They cause very little collagen production and the newer ones contain lidocaine which is a nice plus for the patient and injector.  These are the most widely used products.

Radiesse is another filler that is made of small calcium hydroxyapetite beads in a sugar based carrier.  This filler is limited in its use and should not be used in the lip or superficially anywhere.  It is great for larger volume fills in the cheek and nasolabial fold.  It works by causing your body to form collagen in the treated areas. It should last 12 to 18 months but will need some supplementation in that time.

Other common fillers are Sculptra which is poly L lactic acid can be used to create volume in the cheeks but this is a much slower process than the other two.

More permanent fillers are fat and silicone.  Fat harvesting and grafting has become common all over the body, but is very popular in the face.  Fat is harvested, treated and placed in areas where fat has disappeared over time.  There is some variability in the percentage of the fat that lives and therefore the procedure may need repeating. Lastly, silicone.  Silicone has received a bad name.  There are countless examples of low grade silicone used in too large a quantity to create a terrible result.  At Total Body Surgical, I have a great deal of experience with silicone.  We use only the best quality silikon 1000 that is manufactured by Alcon and made for use in the eye.  It works great for augmenting lips, filling areas of imperfection on the nose, and some acne scarring.

Next week....we'll address pigment issues!!  Come see us at Total Body Surgical.  Mention this blog and get $10.00per unit botox....That's a good price now!!

 

 

Last week I began a discussion of common skin care complaints.  Today I will discuss one of the common complaints.....wrinkles...

Now this kid has a cure for everything.  Check out his routine!!

http://youtu.be/X5kFQW7W7_k

What causes wrinkles?  Well, that is a big question but the answer is about the same for everyone.  Time, as in aging, is the primary culprit.  We all make facial expressions that are common.  We all scowel from time to time, we smile, frown, and elevate our brow.  When young, we produce collagen at a rapid rate and elastin that keeps the skin flexible even when the underlying muscles wrinkle the skin.  Skin also produces more oil and moisture when young adding to its pliability.  At around age 30 most of us stop producing collagen at a rapid rate and we gradually develop a net loss of it.  When this happens, the skin, in response to constant pressure from the underlying muscles of expression, begins to gradually show wrinkles.  These wrinkles are seen in nearly everyone starting around age 40 but can occur much later or much earlier.  Genetics takes a part in when the process starts as well.

What can we do about them??  You can start with prevention.  This starts with a good skin care regimen.  The most important part of this regimen is sun screen to protect from UV damage.  For the remainder of the care, at Total Body Surgical Cosmetic Surgery, we recommend the Obagi line of medical skin care.  These products are fantastic at slowing the process of aging, i.e. wrinkles.  When used properly this line stimulates collagen formation and keeps the skin young longer.

When skin care is used properly, wrinkling can and eventually will continue to occur.  When this happens, the best product on the market, hands down, is Botox or Dysport.  These products are time tested, safe, and VERY effective when used properly.  We use Botox by the gallon and everyone loves it.  Wrinkles that are too deep for Botox may need to be Filled.  I will cover these products in my next chapter.

Come see us at INTEGRIS Total Body Surgical for a full line of Obagi products and Botox.  Mention this blog and get Botox for nine dollars per unit (about $300 for the full upper face).  You need to mention this blog though when you book.

Cosmetic consultations and skin care consultations are complimentary!!!

The next few weeks I will be covering, in this blog, my philosophy and approach to common skin problems.  I hope this will be helpful to some of you. As a cosmetic surgeon, we see these problems commonly.

For a good laugh with a little ring of truth. 

http://youtu.be/byTMPyzq7O8

What are the causes of skin damage, pigment issues and other skin problems?  The answer to that question is fairly complex.  We do know some of the answers but certainly do not know them all.  First of all.....exposure.

Have you ever seen a new car that was wrecked and then left out in the elements???  Over time, the paint becomes dull, faded, and if you rub it, it comes off on your finger.  This is called oxidation.  The same thing happens to our skin over time.  Elements in the air.... pollutants, and sun work on the skin from the outside making it less youthful.  The other factor that works on the skin is what we put IN our body.  To use the car analogy, if water gets into the metal under the paint, you get rust from the inside.

So, all analogies aside, our skin is effected by exposure and what we eat.  There are 3 or 4 main problems that people complain about related to their skin:  First is wrinkles...these are caused by the skin adapting, over time, to motion of the underlying muscle.  Add this to the aging process where our bodies produce less collagen (the substance that gives our skin strength) and less elastin (the substance that gives our skin elastic qualities).  This process goes on even when we remove all of the other variables unfortunately and actually has been proven to start in the late 20's age group which is not considered old to me.  These wrinkles are very predictable.  They occur between the eyes (the elevens), around the eyes (crows feet), across the forehead, and around the mouth.  They are created by frowning, squinting, pursing the lips, and elevating the brow.  The second problem people complain about are pigment issues....brown and red "spots".  These are caused by changes in pigment production and areas of blood vessel changes in the skin, usually related to UV (sun) exposure.  The third problem is "sagging" of the skin.  This is again related to loss of collagen and skin elasticity but is contributed to by loss of underlying support structures, i.e. facial fat.  The fourth problem people complain of is the developement of "lesions" or rough areas that may or may not be pre-cancerous.

In the next blogs I plan to cover these issues one by one and give you some ideas on how to deal with them.

Come see us at INTEGRIS Total Body Surgical for your skin care concearns.

Remember to check out our Breast augmentation and hair removal specials too!!!

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

-Laser services

 

Well.....things have changed!!  Thank God!!  What has changed is advancement in ultrasound and laser technology.  Stripping was done to remove the vein that was causing the problem.  The laser heat seals and closes the vein accomplishing the same result without any of the downside.  The procedure is done in the office under mild sedation, patients walk in and are required to walk 30 minutes after the procedure.  The down time is minimal and I require patients to wear stockings for 2 weeks after avoiding strenuous activity. Large varicosities are removed through very small punctures in the office as well with no stitches and after a short time, essentially no sign of surgery. In most cases, if symptomatic and the ultrasound proves disease, insurance will cover this part of the treatment. Spider veins are then treated with sclerotherapy which usually is not covered by insurance but is very affordable. Afterwards, legs are nearly as good as new and usually none of the pain persists. Best of all you can take advantage of all the summer fashions. The success rate is around 80-90%....very good.

Come see us at INTEGRIS Total Body Surgical and get a great deal on cosmetic sclerotherapy after Laser ablation!!

COOL TOUCH LASER ABLATION

 At INTEGRIS Total Body Surgical, we provide the latest in total vein therapy.  When I first started in surgery many years ago vein stripping was the norm.  It usually required multiple incisions and a fair amount of blood loss.  The procedure was done under general anesthesia and required a prolonged recovery and left unsightly scarring.   The success rate was about 60=70%.  We know that this condition, known as chronic venous insufficiency, is inherited and aggravated by long periods on our feet and pregnancy.  It can also be caused by trauma, deep vein thrombosis and other abnormal clotting states.  The symptoms are caused by malfunctioning of the valves in the venous system.  Because of this, the venous blood pools in the lower leg causing pain, swelling, spider and varicose veins, skin color and texture changes, and possible ulceration.  It can cause restless leg syndrome, and makes them look bad.  Many people no longer wear dresses, skirts, shorts, or any other attire that shows leg because of embarrassment.  Others spend their life in hot and uncomfortable stockings with their legs elevated at night to deal with the discomfort. 

More later in the week on treatments.

 

  At INTEGRIS Total Body Surgical, Through July, we are offering $150.00 off of one sclerotherapy session if you screen and qualify for laser vein closure. See the link below for sign up and more details!!! Or call 918-786-7780 Today....don't miss out!!

http://www.totalbodysurgical.net/love-your-legsagain/

Video on how it is done.

 

Eyelashes....you don't have to go to these extremes!!! Forget false eyelashes, extensions, and mascara that makes you look like a horror movie actress at the end of the day. There are now products on the market that can make your lashes grow....and no it is not like Rogain, creating only fuzz. These products make your lashes grow in a matter of days. They get darker, longer and thicker, to impressive levels. Several companies are producing products that work. I will talk briefly about Latisse as it is the one most people know about. Latisse is the same medication that is used in Lumigan. Lumigan has been around for a long time as a treatment for glaucoma. It was noted that one of the side effects of Lumigan use was eyelash growth. We, in the Cosmetic industry, used to use Lumigan to lengthen eyelashes but we used the drops IN the eye. One of the side effects was a permanent change in eye color. This did not effect women with brown or black eyes and women with very blue eyes had little problem either. It is the women with blue eyes that have darker pigment mixed in and these are the people that may have darkening of the iris. Latisse is applied topically to the lashes and it seems to work just as well as the drops if not better. The nice thing is that the side effect of a darkening iris is still present but very rare as very little medicine actually gets in the eye. Once you begin to use the product, you will notice a change in your lashes within a week in most cases. You will see new lashes starting to grow and the old ones start to darken and become thicker. You will be amazed and love the results. Many girls actually have to trim them. It is truly one of those OMG products that WORKS!! Those of you that know me know that I refuse to promote something that does not work and this product does. There are other rival products being marketed right now but I have little experience with them. OBAGI has a new product that we are dying to try and there are several others. I will give you my recommendations after we gain some experience. We carry Latisse at our office and our daily price is $100.00. Our girls will teach you some tricks on how to extend the life of your purchase too. We can ship the product to you if you like and soon it will be availble through our on line store once we get it up and running. Come see us and don't forget our look Grand on Grand breast augmentation promotion through May: $3699. for saline and $4899. for silicone implants. www.totalbodysurgical.net 918-786-7780 Friend us on Facebook!!