Total Body Surgical Blog

  Do you ever feel like this?  What is a brow lift and when do I need one?  How do you know if it's the eyelid or the brow?  This week I hope to give you the information you need if you have these questions, or know someone who does.

  Many people show up to the office wanting their eyelids done.  The eyelids droop, look bad, and sometimes even effect their vision.  The question is..this, is it the brow, the lids, or a combination of the two?

If you look closely at this picture, what do you see?  First, it looks like her lids are drooping.  On closer inspection, the problem is a little more subtle.  If you look at the brow position, it is very low.  There is a hood over the outside of the eyelid and out over the outside of the eye.  This is a tell-tale sign....lateral hooding.  The second thing you notice is how low the eyebrow is in relation to the eye.  In females, the normal position should be above the boney rim of the upper eye and should have an arch to it that is highest at about the outer iris (colored part of the eye).  Her brow is far from being in the proper position...it is very low.  She may come asking to have her eyelids fixed, and without further examination, she may be right, but the primary problem is her brow.

Brow ptosis, or droop, is a problem that can be multi-factorial.  It is partially hereditary and is added to, as a problem, by facial fat loss.  It can cause cosmetic issues, making you look older, tired all the time, and causes wrinkles in the forehead due to over-use of the muscles in the area so you can see.  Brow ptosis can also cause visual field problems.  Our peripheral vision is dependant on a clear field of vision, up, down, medial and lateral.  What the droop can cause is an occlusion to the vision.  Once the brow falls significantly, it is like having blinders on a horse, you can only see straight ahead!

In many cases, the brow droop is accompanied by upper lid laxity (blepharachalasia) as well.  When this happens, we try to address both problems at once.  For older patients with visual problems, we establish the problem exists first by doing a "visual field" test.  This establishes if your vision is actually effected by the extra or low tissue.  Then the lid or brow is taped out of the way and the test repeated.  This allows us to tell if removing eyelid tissue or elevating the brow is indicated, or if both are indicated.(Visual field testing.)

 This is a great example of an eyelid problem only.  If you look closely you see that the brow position is exactly as we discussed.  The brow is in a good position as far as it relates to the boney part of the eye socket, and it is arched nicely.  Also note that there is no lateral hooding present as we saw in the previous picture.  It is the eyelids that are the problem and a simple blepharoplasty is sufficient to fix this.  This is a great result by the way, off of google images.

 A blepharoplasty means removing skin from the upper eyelids and often a small amount of fat.  This gives you back the lid platform for eye make-up, makes you look less tired, and is very rejuvenating, knocking several years off of your appearance.  I usually do these in the office, mostly under local.  It takes about 45 minutes or so, you go home after, there usually is no more than minor bruising, and after healing several months, you can't even see the scar.  It is a great procedure.

When a brow lift is done for cosmetic purposes.  I do them using a scope and a camera.  Some people still make a large incision on the scalp but I think the scope gives great results without significantly moving the hair line and without a big scar.

This picture depicts where the small incisions are placed for a brow lift.  We shave no hair, the hair line stays the same, and the results are just as good as the old big incision.

This shows a nice result from a brow lift.  She looks much younger and the hoods that she had before are now gone.  The brow position is arched and good...no surprised look.

If you are dealing with these problems, come see us today at Total Body Surgical.  We can help...call 918-786-7780 or 1-877-weight-0.

Last week we talked about treatment of facial redness, facial veins, and rosacea as a cause.  Most of these treatments involve some type of light therapy or laser treatments.  The laser is used to close visible veins on the face and at the base of the nose.  It works by damaging the lining of the vein, it ceases to function, and your body eventually gets rid of it.  Of course, some new veins may appear with time and may require further treatment. 

 just a reminder..

For the redness associated with aging and, or rosacea, we use IPL (intense pulsed light).  The intensity of the pulse of light also targets the red pigment in the smaller capillaries of the skin of the face, causing them to close.  After a short time, the redness is much less.  In many cases, we will use the laser and IPL at the same time, closing the larger, visible veins with the laser and the generalized redness with IPL.  The IPL treatments also can target "age" spots on the face, or areas of Melasma (mask of pregnancy or pigmented areas).

 melasma   age spots

These areas are caused by Ultraviolet light (sun) exposure and hormonal changes.  This is why we recommend not tanning your face!!!, or use sun screen on your face and re-apply often.

OK, after this reminder of what we are trying to address with the laser...what is, and why do you need "pre-treatment"?  First of all, we want the treatments to be as effective as possible.  If you pre-treat the skin, the dead layer or stratum corneum is not as thick and the light used penetrates better.  This, of course, gives a better result.  The other problems that can occur with light therapy are:

-hyperpigmentation:  in other words, the skin cells that produce the pigment in the first place can respond by making more....not what we're looking for.

-hypopigmentation:  loss of skin color.  The pigment cell stop working and the skin becomes too light.

-persistant redness:  redness of the skin after treatment that can hang on for months.

Of course the percentage of people that have any one of the three of these happen is very low, however, we want to decrease the risk as much as possible.  How do we do this?....by pre-treating the skin of course.

What we, and most others, use is a combination of a retinol compound, and a fading agent.  Retinol compounds are derivatives of vitamin A.  (retinol, retin-a, tretinoin, etc.)  There are chemical differences between them, but the end result is to compact or thin the outer, dead layer of skin and stimulate the live, basal layer to turn over quicker and thicken.  They also retard the degradation of collagen and slow down the darker pigment cells that create dark spots.  All retinols will also dry the skin to some extent and decrease oil production.  These effects are great for acne and for some forms of rosacea.  The other product we use is a hydroquinone.  Hydroquinone works by inhibiting an enzyme in the melanocyte (the cell in the skin that produces pigment) that is critical in forming the melanin or dark pigment.  By stopping this pigment production before any light treatment, we can decrease the likelihood of hyperpigmentation as a problem.  The continued use, after laser or light therapy, of hydroquinone keeps the age spots and, or melasma from returning.

Of course, pre-treatment does not guarantee that any one, or all, of the problems that can occur will be prevented.  But pre-treatment does greatly lower the chances.  The darker the skin, i.e., ethinic skin, the greater the chance of problems with or without treatment.

At Total Body Surgical, we use the Obagi line of skin care products for pre-treatment and maintenance.  It is medical grade (prescription grade) and works very well even if laser or light therapy is not used.  Our pricing is great and we start people on the travel size products so they don't buy large amounts to start with.  If your skin cannot tolerate it, (very unusual) or if you don't like it, you have not made a huge investment.

So come see us for facial pigment issues, rosacea, or acne.  We have the experience and equipment to help you.  Cosmetic consultations are complimentary so call 918-786-7780 or 1-877-weight-0.

I hope everyone had a great 4th....time to get back at it. 

One of my friends asked me to address those unsightly veins that show up on the face.

  Here is a good example of what I'm talking about.  These are from a condition called rosacea that causes inflammation and eventually the larger veins that appear on the cheeks and around the nose.  The problem is usually made worse with heat (i.e. working in the yard during summer) or consumption of red wine.  It can occur in all ethnic groups but is much more visible in the lighter skinned groups. Rosacea is treated with topical medications, oral medications, and light therapy which will be covered later. 

 Rosacea can also have a deleterious effect on the color and shape of the nose.  Known as "rhinophima", the nose becomes red with acne like lesions that eventually cause the nose to become misshapen.  It can also cause very large veins to become visible.

 The veins that appear at the base of the nose are very common as we age.  Some people have them worse than others of course, but lighter skin tends to allow them to show up more prominently.  They can occur with or without rosacea.

 Here is another example of a facial vein that sometimes bothers people.  This is known as a facial reticular vein.  They can occur around the eye and temporal area.  They are present in young and old alike.

 In some instances, instead of visible veins, just a "redness" is seen.  This probably is just early rosacea and should be treated as such.

How do we treat these problems?  The treatment depends on what the cause is and how severe the problem has become.  With rosacea, we treat it topically and sometimes with low dose antibiotics when it is early and large venous areas are not present yet.  Once outbreaks are controlled, the redness usually subsides.  If it does not, the next step would be to use Intense Pulsed Light treatments to close the small capillaries that are flushing and causing the skin to turn red.  These treatments (also known as IPL) use bright flashes of light of a certain wave length to damage and close the small vessels that are causing the problem.  Usually several treatments are required, sometimes up to 5.  These treatments will controll the problem for some time after, but usually not permanently, so treatments may be required every few years or so.

For the larger veins, in the cheek, nose, and base of the nasal area, we use the vascular setting of the Cutera 1064 YAG laser.  Using a very small spot size, the veins can be closed and they are no longer visible.  In some cases, we will use both the laser, and the IPL in combination.  This treats the redness that is generalized and the larger veins that are too large.  The treatments are generally pretty quick and the discomfort is tolerable.  We use numbing cream for most as well as the Zimmer chiller that blows cold air over the treated areas.  For larger treatments we will call in Valium if needed.

Reticular veins around the temples or eyes are also treated with the YAG laser.  They may be a little sore after treatment for a few weeks until the body resorbs the vein and some bruising is possible though not very common.

The nasal effects of rosacea can be severe if left untreated.  The laser is used to control the venous problem and it helps with the sebaceous problem as well.  Left alone, the nose can turn into a trunk so treatment is necessary.

All of these treatments are done in the office with little or no sedation.  The treatments alone are fairly quick, taking only a few minutes.  Usually there is only a mild amount of redness after, though there can be some areas of ulceration or skin slough.  These areas usually heal very well.  Ideally, you come in and have the treatment done, leave with a little redness, after that resolves, the veins and redness are gone or greatly diminished.  As I said before, more than one treatment is usually required and are done 4-6 weeks apart to allow for healing.

So, if any of these things are bothering you, give us a call at 918-786-7780 or 877weight0 toll free.  If you have any questions, fill out a contact form and I will try to answer it for you.

I hope this helped some of you understand a very common problem.

For the past several weeks I have taken the time to reflect.  Some of the time has been spent venting here, mostly, the time has been spent on my back deck looking at the lake and re-evaluating some things.  This week I wanted to touch on a few points that I think are important and how they relate to Cosmetic Surgery and Bariatric Surgery...namely, happiness and fulfillment.

Now first of all, I am not a philosopher.  I did take several classes in the subject in college and I have read philosophy since, but I am not a pro. 

As children, all of us start off pretty happy.  We really have no point of reference to create sadness.  Whether we are rich or poor, have good parents or not, are good looking or not as good looking as we think we should be, we are usually content with our existance.  Then society steps in to tell us all the reasons we should not be happy.  The TV tells us that if we don't have this gizmo or that, this car or that car, blah blah blah, we are inferior to others.  The process worsens in school as peer pressure takes over, and the process goes on and on as we get older. 

We all reach points in our life where we are not happy with some portion of ourself or our situation.  Maybe we are overweight, maybe there is something about our body that is making us unhappy, maybe it's our job, family, belief system, or a combination.  I personally think that it is OK to be unhappy about some things and it is OK to strive to improve them.  For instance, if you were unhappy with your employment situation, you could start investigating new career options, start taking some classes, if that is what is needed, and start a new career path.  If your marriage is not so great, you and your spouse can seek counseling sessions to find out why your compatability has waned and start communicating better.  We have all seen situations like these where people improve their lives dramatically with a little self improvement or education.

What if we are too heavy?  Of course starting off with exercise and diet may help.  Physician directed diets and medication are also accepted methods and are, for some, successful.  However, when they fail, it is also perfectly acceptable to seek a surgical option.  My philosophy is fairly simple when it comes to bariatric surgery and similar to the philosophy when treating drug abusers....if you don't get it under control, it's going to kill you, so do whatever it takes to get it under control.  For any addiction problem, it may mean drug rehabilitation and for the morbidly obese, it means bariatric surgery.  The two problems are very similar as both deal with controlling desires and changing lifestyle.  Rehab is a tool, and so is weight loss surgery.  Let me tell you, once a person loses 150 lbs, they become happy.  They realize that the extra person they have carried around for all those years has made their life miserable, socially, physically, and otherwise.  Life for these people becomes much more fulfilling because they are happier, their self image restored.  They are now able to get out of the house, socialize, play with their children or grand children, work and become better providers.  Most of all, they get rid of the stigmata of obesity that society tags them with.  I find this an exciting and life changing event.  We have one life to live so live it to the fullest.  If your weight is prohibiting this and all else has failed....what's stopping you?  Don't let those that don't have the problem dictate what you do.  Obesity is a dangerous problem that WILL shorten your life so fix the problem if you can.

Cosmetic surgery falls more into the "want to" category, but is no less important.  People that have some sort of Cosmetic problem are no less self conscious than the obese person.  Whether it is breasts that are too large or too small, stretch marks after children or a sagging lower abdomen, or facial changes that occur with age, all can cause a person to be less able to fully participate in society, be happy, and fulfilled.  We have the ability to correct these problems so why not be happy.  Of course most say that "happiness comes from within" which is a statement I believe in.  However, if fixing a Cosmetic problem gives one the self esteem to let that happiness out....I say fix it!  Again, don't allow others to dictate what will make you happy, and remember that most of them would have something done if they could.

Our lives are a gift from God.  It is our job to make the best of that life.  Live every day like it is your last, and do whatever it takes to be fulfilled and happy, even if that means fixing something.  Love deeply, laugh out loud, cry when you need to, make good friends and cherish them, treat others like they are family (but love your family a little more), hug everyone, and most of all, thank God every day for what you do have in life.  Pretty simple, but now you know my philosophy. 

Come see us....we will treat you right, and Cosmetic Consultations are always complimentary.

918-786-7780 or 1-877-weight-0.

A good friend asked me to talk about fillers this week and I promised I would, so here goes.

First of all, what is a filler and why would someone want to use one??  Fillers are just what the name sounds like.  As we age, we lose volume in our face.  We lose it around the eyes, in the cheek area, and in the folds around the mouth and lips.  This is caused by hormonal changes and in many cases, genetics plays a significant role.

  As you can see in this graffic, as volume is lost, the skin begins to respond to gravity and "folds" in typical spots start to form.  Nasolabial folds are the most common, forming around the base of the nose to the corners of the mouth.  Secondly, "bags" begin to form under the eyes.  This is due to shrinkage of the fat pads in the cheek area that, in younger people, "windowshade" the fat pad under the eye.  This creates the dark circle under the eye which is really shadowing, as light is blocked by the overhanging fat pad.  The other commonly effected areas are the "marionette lines" at the lower corners of the mouth and vertical lip lines.  One other common complaint is thinning of the lips and loss of the youthful shape of the lip.

This picture depicts the "cone of youth" and how aging turns it into a box.  Again, most of this is due to loss of volume and loss of skin elasticity.

Now that we have covered what happens, what can be done about it?  There are a few ways we can correct or reverse the aging process.  The first thing I recommend is good skin care.  It wouldn't be right to fix up a vintage car and not re-paint the thing would it?  You want your skin to look as youthful as possible and I think Obagi is as good as it gets for that.

Second, we have to increase volume.  Even when we do face lifts to remove excess skin, most of us will add volume to fill up the upper part of the face...this is youthful.

The first and best way to increase volume is with facial implants.  They are solid silicone and never go away....one time and that's it.  The second best way is with fat grafting.  We use your fat, process it, and place it back in the face.  This is good because it can last a pretty long time...5-7 years.  The third way is with fillers.

Fillers have been around quite a long time.  First came collagen fillers that only lasted about 3-4 months and required skin testing.  We now have them that last a year or more and can be used in anyone.  The most commonly recognized one is Juvederm.  It is made of cross-linked Hyaluronic acid (HA).  HA is a substance that is present between our cells naturally.  Juvederm is clear and almost jelly like.

  It can be used literally anywhere in the face.  We use it to fill the cheek area, the nasolabial folds, marrionette lines, and lips.  It can also be used to correct nasal deformities or acne scars.  Think of it as putting dirt in a hole in your yard without disturbing the grass.  It is used to fill deformities or add volume to the cheek area, the nasolabial folds or marrionette lines.  It can be used to make lips larger or reshape them.    The second type of filler non-occuring in the body and made of a calcium compound mixed with a sugar based carrier.  This filler is good for volumizing but can only be used in deeper tissues. 

Radiesse is great for liquid face lifts where we place volume into the cheek area, lifting the face and restoring volume.  It can be used in nasolabial folds and carefully in marrionette lines.  It cannot be used in lips or in the dermis (skin).  Most other fillers on the market are made of HA, regardless of the name, except Artefill (made of collagen and spheres of solid material) and Sculptra (made of a powder material that causes collagen to form).  These two materials are made to inject deeply and last 5+ years.  All fillers have advantages and disadvantages.  You must consult with your injector to know which one is best to get the result you want.

My preferences are for Juvederm and Radiesse, for shorter term fillers.  I use silikon 1000 for my long term filler as it never goes away.  I use it to make great looking lips that stay.  I do small injections a month or so apart to get the right amount of correction.  Hope this helps everyone.  We love fillers and do them very well.  Call today and come see me at 918-786-7780.  All cosmetic consultations are complimentary.

Possibly more changes on the horizon for weight loss surgery are in the making.   

These changes will have an effect on the entire landscape of bariatric surgery in the U.S.  First, a little history....

When bariatric surgery first started (weight loss surgery) there were few regulations and a multitude of procedures that were tried.  All procedures were done through a large incision and most of the patients are high risk due to their weight and many other additional medical problems brought on by the weight, i.e., diabetes, high blood pressure, heart disease, sleep apnea, etc.  This combination led to a high complication rate and high mortality.  What has changed in the past several decades to make these procedures much safer is the innovation of laparoscopy.  This allows us to do the procedure with tiny incisions, fewer wound problems, much less pain, and shorter hospital stays.  Other changes that have happened are the standards that were set for bariatric centers. These standards were fairly rigid and the procedures done were made more standard.  What we have learned is the bariatric patient needs a higher level of pre-operative evaluation and post-operative care than the average patient.  Because of this, the American Society for Bariatric Surgery was formed and guidelines were created to improve safety and "centers of excellence" were created.  Centers of excellence were formed based on criteria set for pre and post op care, and a minimum number of cases done in a year. 

After gaining experience and analyzing a ton of data, it was discovered that the center of excellence really does not change outcomes.  What this means is you can have a procedure done at a center of excellence or a non-accredited center and have just as good an outcome.  The net effect of the center of excellence has been to limit access for medicare and medicaid patients with no real benefit.

After joining forces, the American College of Surgeons and the American Society for Bariatric Surgery are trying to change (in my opinion for the better) the center of excellence guidelines.  Here is what the proposed changes will look like:

1. Three divisions will be set up, the first being band centers, where only lap bands will be performed.

The Gastric Band on the stomach.

The second division will be "low acuity" centers of excellence.  These are smaller facilities "like INTEGRIS Grove hospital" that have qualified surgeons but limited ancillary services.  These centers will be able to do staple procedures on "lighter" individuals with few other medical problems. In other words, healthier, lighter patients will be able to have their procedure done on a more local basis and not have to travel to big centers.

Sleeve gastrectomy                                               Gastric bypass

In these lower acuity centers, the work up is the same and all of the patients are tracked by a National Data base.

The third division is the high acuity center.  This is where heavier and more complicated patients will have to go, usually in the larger regional hospitals.

This is the proposal that was sent to the CMS (Medicare).  However, they have different ideas about the whole thing.  CMS, looking at the data, thinks that possibly communities would be better served if the whole center of excellence thing was just eliminated.  They do have a substantial amount of data that shows there is no improvement in outcomes.  Now the Politics come in.  What politics?  Well, current centers of excellence don't want any change and centers that want to gain this distinction can't because the number of cases that must be performed, under the current rules, cannot be reached.  The number of people needing the surgery continues to grow and many cannot get to a current center of excellence for care.  My feeling is that if you have a qualified surgeon and a program in place....what difference does it make.  People that need the surgery should not have to travel hundreds of miles, and according to the data, it makes no difference.  Hopefully, a reasonable compromise will prevail....and soon.  Many programs, ours included, are sitting on go, waiting for some sort of direction.  In the mean time, we are limited to private pay patients and private insurance patients currently.  We are looking for some type of decision in 2014 and are hoping for good things.

   Of course the changes will mostly only effect Medicare and Medicaid patients but some private insurance as well.

So that is what's on the horizon...better access.  We hope to be a low acuity center in the very near future as Dr Miller is fellowship trained, certainly qualified, and ready to go!

Our cash prices are pretty good too (see below) and you don't need to travel to Mexico either!!

So come see us today!!  Cosmetic consultations are always complimentary!! The spring laser liposuction special is going on so act now to reserve your time!  918-786-7780 or 1-866-weight0.  And don't forget our low prices on breast augmentation either!!!

Keep an eye out for the news reports on the sleeve gastrectomy!!!

I have been out of the picture the past several weeks.  I apologize to those of you who read my blog and look forward to it.  To those who don't....I wish you would.  The reason I have been remiss is that my daughter Rachel was killed in a boating accident on the lake here in Oklahoma.

I just wanted to use this forum (I don't know or care if it is appropriate) to tell as many people as possible how very special she was to so many.  Those of you who have children will know a little of what I mean.  Those of you who don't, well, hopefully some day you will experience love like we have for them.

Rachel was born in January of 1992 (all of my girls were born in January).  She was such a blessing to us from that time forward.  She had a head full of black, curly hair and was a little grumpy at first but this soon passed.

Sarah is Rachel's older sister and she was so excited to have her arrive.  Sarah called her "baby Rachel" and was constantly singing to her and entertaining her any way she could, including filling her crib with stuffed animals.  At that time we were living in Dyersburg, Tennessee on a small farm.  The girls loved growing up there.  They spent a good deal of their time outdoors playing, looking at bugs, watching birds and butterflies, playing with the dogs, and just enjoying themselves.  Rachel was a very dramatic child.  She loved the camera and hogged all of the video she could.  Poor Sarah rarely was in a shot by herself but she didn't mind.  Rachel was always smiling (my friend Montie called it that Swetnam shit eating grin).  Our next door neighbors, Larry and Jennie Sue, were like grandparents to them.  We shared holidays with Easter egg hunts and Miss Jennnie Sue was always decorated for Halloween and Christmas and the girls could not wait to go look, over and over.  Mr Larry would take them on "nature rides" in his golf cart and they would look at bird nests and the garden.  They cherished the time and Janet was happy for a little break.

Rachel loved clothes and fashion as an adult.  I think that came from two sources.  The first was a bag of "dress up" clothes that a friend gave Janet.  The girls were constantly dressing in them and wearing them around the house.  Whenever friends came over they would all dress up and have fashion shows.  They were pretty funny and bring a smile to my face as I think of it.  One time at Miss Angela's, Rachel and Mallory shaved their legs in the tub.  I think they were three. Janet and Miss Angela were mortified...Rachel was always ahead in fashion and personal care.  The stoles were VERY popular and Sarah and Rachel would wear them while riding our golf cart.  Hot or cold they would have them on, the golf cart at full speed with a dust cloud behind, waving and smiling as they went by. 

That poor golf cart.  The girls would have friends over and they would be hanging all over it, riding around in the fields.  When her cousins Jake, Alex, and Andrew came over they would get driving lessons.  The golf cart finally did die, but not after at least 100,000 miles.

We had numerous pets when they were growing up, dogs, cats, hamsters, fish, owls that were found after storms, horses, sheep, peacocks, you name it, we probably had one.  If one of them died we would have a funeral in our pet cemetary....Catholic Mass of course....and everyone, including our neighbors would have to come.

When school started the girls made a whole new pack of friends.  Miss DeeAnne was their art teacher and I think that is what cultivated Rachel's creativity.  She mixed her love of art and her love of clothes....fashion design came out.  The girls had a great time in primary school in Dyersburg.  Camping with Miss Jane and Anna Claire, hanging out with Mallory and the Lemons girls, Kayla, Hannah, Anne Taylor clicking through the house in those high heels, and too many other friends to name.  Uncle Kevin, Aunt Brenda and Aunt Mary(not really even related except in the heart), Uncle Greg and Aunt Kris, Aunt Caren, Uncle Steve and John, Uncle Craig and Aunt Tammy, Uncle Putsy, all the Louisiana cousins, greased pig contests, 4th of July fireworks at the club, and the county fair...I could go on all day, these were great times.  They were good girls, only having to "go to the wall" at lunch once or twice.  Janet and I made a lot of friends too, getting to know other parents at functions and birthday parties.

In middle school, Sarah paved the way for Rachel and when she got there, she was "in charge".  The principal, Mr Mickey, was so kind to my girls and loved them.  Of course they loved him back and Rachel would sit in his office at lunch and give him suggestions on how to improve the school.  This went on through high school as Mr Mickey took the high school principal position later.  He was always nice enough to humor her.  Rachel and Sarah were always funny and smart in school and Mr Mickey appreciated that.  Not treating them like kids, but enjoying their blooming personalities.  Until the day she died she would talk about him.  High school was filled with friends and laughter, too many friends to name.

Rachel and Sarah were cheerleaders from middle school through high school and Rachel and I took Tae Kwon Do together through the Lewis institute....yes she was a first degree black belt.  We had a great time with Master Lewis and our classmates going to tournaments and giving me a chance for some one on one time with her.

I left Dyersburg for Tulsa when Rachel was 15 to do a Cosmetic Surgery Fellowship.  I flew back and forth on the weekends.  Rachel and Sarah liked to fly, Sarah because it made travel quicker and Rachel so she could pee in the airplane pee bags.  She loved it when the pee turned to a gel.  I can still see her face, smiling and peeing in the bag, Sarah complaining that it was "gross".  One weekend my friend DY flew Rachel and Anna Claire to Rogers, Ark and I picked them up and brought them to Tulsa for the Tulsa State Fair.  We had the best time looking at all the animals and going to the rodeo and concert after.  They thought that the cowboys were "cute", and maybe Oklahoma wasn't so bad.  In high school Rachel took FFA believe it or not and showed sheep (little Jerry Seinfeld was her first).  She also loved beauty pageants and won or placed in a number of them, her last one was miss teen Oklahoma which she won.  She was probably the first with a thick Tennessee accent but she made a number of very close friends there and had a great time collecting books as her project for the kids of Tulsa. Rachel loved kids and old people.  She could talk to anyone and enjoyed visiting with elderly people, going to nursing homes, and watching the kids at our local Church.

At age 16, Rachel had a bad car accident.  Our road was closed due to bridge work and we had to use an alternate, narrow, curvy, blacktop to get to town.  One rainy morning while she was heading to school her front wheel went off of the side of the road and when she corrected, the car went off of the road into a gully, flipped over, landed on its top on an old truck bed.  The car was totaled and the man behind her thought she was surely dead.  She was just knocked out but had a concussion, a broken collar bone, and a cut on her forehead that she would only let me sew up.  We were lucky that day.

  Rachels junior year we moved to Tulsa.  She was always so excited to move from Dyersburg....until we did.  She had a hard time at first but we kept encouraging her.  Our good friends in Tulsa, Bob and Stephanie, told us she needed to go to Cascia Hall, a prep school, and we said sure.  We interviewed there and they were not excited about Rachel at all.  They felt she would not fit in academically.  Stephanie said "she is going to Cascia", and it was done.  We got her tutors to get caught up and Rachel took off like a bird in the academic world.  We were so proud.  She also lit up the social life there making tons of new friends, many of which she introduced to her old friends who still remained close.  Our house was always full of new people....they loved to hear her talk.  She really matured and later commented that that was the best move we ever made.

Sarah was gone to Oxford and Ole Miss during this time but encouraged Rachel.  We made frequent trips to games there to watch the Rebels and had a great time.  Rachel really liked Oxford but in the fashion world, Fayetteville was where it was at for her.  That was good because the SEC is the only conference in her eyes.She learned to "call the hogs" with the best of them and we did too.  She pledged Tri Delta and for the most part had a good experience making many close friends.  She had such a great time at Arkansas and loved her major.  Her freshman year she had to go through the draw for a roomate, due to a last minute change, and met Wesley.  They lived in a small suite with four girls and one bathroom...quite a feat...but they had a great time.  Wesley is how Rachel met Trey (the boy who was also killed in the accident).  Rachel and Trey never dated or had any romantic interests, they just loved each other and loved being together.  When they were alone, they each would draw a crowd because they were usually happy and made everyone feel good about themselves.  When they were together, it was crazy the crowd they could draw...like moths to a flame.  They would laugh and cut up constantly, argue and fight like brother and sister.  Trey would come to our house often when nothing was going on in Fayetteville and we would all laugh at their escapades.  Janet would cook some good Cajun food and that would get them all fired up to come.  We had a blast just watching them. They took great pleasure in the most simple things.  Rachel enjoyed every second and Trey went along for the laughs.  Just going to Wal-Mart was exciting for Rachel.  She worked at Rif Raf in Fayetteville, a clothing and vintage store, and loved it.  From what I hear, the customers and owners loved her back.  She amassed a very large clothing collection from there (I don't think she ever made any money), but that is what she loved.  Rachel, in addition to her degree in fashion, would have had a minor in Mandarin Chinese.  This was something she worked very hard at and enjoyed.  She started Chinese in high school in Dyersburg, it was supposed to have been French but a last minute teacher change fixed all that.  She liked drawing all of the characters that is required in Chinese and laughed while teaching her friends phrases.  She had been on the Deans list for every semester at Arkansas and carried a 3.8 GPA.....she was very smart and credited study habits she learned at Cascia for her college success.Rachel also had a bucket list.  Funny for a girl her age, and I think it changed daily.  She would add things as she did them instead of the other way around.  I found that funny and she could not understand why.  The simplest things were added...I think kissing Mark in the rain was the last one...good for Mark.  I am sad she did not get to complete it here on earth, but ultimately, heaven was the biggest item on it so I am sure she is fulfilled.

Rachel's future was very bright.  Her studies required an internship in the industry and she was slated to go to LA with my niece Paige (also in the fashion game) for an internship with Missoni and Rachel Zoe.  I am sure she would have lit the place up and there would not have been a dull moment with Paige and Rachel together.  Paige told me "it's like getting a big box for Christmas...and now I can't open it",  I feel bad for her, they would have had sooo much fun.  She also had landed a small part in a movie about Brian Burlsworth, a lineman from Arkansas that was very popular and loved, who had just been drafted by the Colts to block for Peyton Manning.  He too was tragically killed in an accident in the prime of his life....how ironic.  Rachel had visions of being discovered, a pipe dream of course, but knowing her, she could talk her way into anything.  (Her and one of her friends, Taylor, once talked their way from the nose bleed seats to standing in front of the stage at a Keith Urban concert....she got to touch his shoe....she could sweet talk for sure.)  We all were looking forward to her exploits, family and friends alike, and Trey and Rachel were rooming together next year, there would have been some fireworks there.

I'm trying to wrap this up but it is hard through the tears.  We all will miss her terribly, Janet, Sarah and I, Rachel had a million "best friends", then she had special "best friends" and ya'll know who you are.  Janet, Sarah, and I love all of you, not only for who you are, but because you loved our little girl almost as much as we did, and you brightened our days.  Thank you all for being there for us and PLEASE don't stop calling.  Rachel's faith was very strong and she once told me she "couldn't wait to get to heaven, it'll be so much fun!!".  I take some comfort in the fact that heaven is where she is, with very fashionable wings I am sure.  I also take some small comfort in the fact that Trey is with her.  They would not have done well without each other, together they were something special.  She is visiting with all of our relatives that are there, some of whom she is meeting for the first time, and I'm sure Miss Jackie is cradeling her on that big chest.  I am also sure she is comforting the little ones that have arrived from the tragic tornados in OK.  Moms, please know that Rachel will watch over, comfort and love them until you get there some day.  I have been doing some reading lately about these mysteries and one of the books says that God does not take our children away from us, nature or man does.  Jesus is there when they cross over, weeping and wailing with us as we mourn their loss and comforting them in heaven.  I believe this.  For those of you who knew Rachel, remember her always, keep her joy for the small things alive in your life.  For those that did not know her, well, just know you would have loved her, you just couldn't have helped yourself, she was beautiful, down to earth, funny, smart, adventurous, and loved to laugh. 

Thank you all for listening, and, as Montie would say.. I love you Rachel Swetnam......

Let's take a break from liposuction this week, we'll wear that out some more later!!

Dr Miller and I just did an interview with the Joplin television station and the topic was addressing extra fat and skin in the upper arms with arm reduction.  I will put a link on the website after it runs if you want to have a look.

First of all...What the heck is an arm reduction?  Also known as a brachioplasty, it is the removal of skin or fat from the upper arm.  

As you can see from the picture, the upper arm has very loose skin with a little excess fatty tissue.  Compared to the lower arm, it looks "odd" and makes some people very self conscious.   Also, when trying to buy clothes, people will avoid sleeveless attire and buying sleeved clothes is hard due to the large diameter of the upper arm.

The image above shows where we usually make the incision.  I normally will liposuction the upper arm to get the maximum reduction, then remove the excess skin.

This photo shows a good before and after.  The results are pretty striking.  The down side in Cosmetic surgery, and the trade off, is always the scar, but these tend to lighten up with time and for most, it is worth it.  Some make the incision along the lower part of the upper arm but I personally think the least visible area is as shown.

Who wants an arm reduction??  There is no single answer to that question.  I guess the easiest person to pin point is the one who has had massive weight loss after dieting or weight loss surgery.  In some, the skin tightens to a satisfactory level so it does not hang, however, in others, they lose the weight, the skin sags and becomes a problem.  In summer fashions with short or no sleeves, the excessive skin can make someone very self conscious.  Some people just gain weight in there arms.  This, of course, is related to your genetic layout.  For some, liposuction will do.  Which procedure is best for you?  That depends on the amount of skin and its quality.  Skin that has stretch marks, is already thin but still hangs, or where there is just too much, will probably benefit from reduction as liposuction can only cause a small amount of skin contraction no matter what technique is used.

The procedure can be done in the office for smaller arms or in the hospital for larger ones.  It usually takes us about 2 hours to complete and is done as an out patient.  Personally, I use drains only in the larger arms and all others I don't.  We like for you to be very careful and baby the incisions for about 6 weeks so the scar that does form is minimal.  Due to the high motion of the area, we will tend to revise these scars more often than most in the office to make them look nicer.  The first time they are closed, there is tension on the wound and this tension, combined with motion can make the scars wider than we like.  When revising, we are only working with the scar.  There is much less tension after revision and they will heal better in most cases.  Many times, we only need to revise a portion of the scar which also makes it easier.

Why the rise in people wanting a reduction?  I don't know the exact reason but I think awareness is one thing.  Many did not know there was a solution to the problem but now do. The other reason is the rise in obesity and weight loss surgery.  With massive weight loss surgery and the desire to "get the old body back" an arm reduction is the only solution for some people.  

Come see us at Total Body Surgical where we are experts at all types of post weight loss surgery....we also do the weight loss surgery, so we have the experience. 

Call 918-786-7780 today or 1-866-weight0 for a consultation at no cost to you.  With you, we will decide which procedure is best.  

Don't forget our laser liposuction deal...$999 per area....can't beat that....call today!!

Now that the breast special is over (just so you know, our usual price for saline implants is still the rock bottom price of $3800!) we're going to wear out the liposuction for a while. 

"Lunch time" liposuction.....what the heck is that?  Most people see liposuction as a very violent and traumatic experience, right?  Here is a brief history of liposuction compliments of liposuction.com:

Liposuction has become one of the most commonly performed cosmetic surgeries in the United States. In 1974, Dr. Giorgio Fischer, a gynecologist from Italy invented the original form of liposuction. French physicians Illouz and Fournier further developed liposuction around 1978. By 1980, liposuction was extremely popular in the United States but was confronting negative publicity due to patients experiencing excessive bleeding and undesirable rippling of the skin after surgery.

In 1985, Dr. Jeffrey A. Klein, a California Dermatologist, invented the tumescent technique for liposuction, revolutionizing liposuction surgery. His “Tumescent Technique” allowed patients to have liposuction performed totally by local anesthesia using much smaller cannulas. Patients could now have liposuction surgery without the fear of excessive bleeding and undesirable skin depressions.

Here you can see the tumescent fluid (numbing medicine, saline or salt water, and a vasoconstrictor) being injected into the fat layer.  This provides anesthesia for the area and helps to minimize bleeding.  Of course, there is a limit to how much lidocaine we can use based on the patients weight and this limits the number of areas we can do at any given time.  Even though larger areas can be done, we do them all the time, smaller areas are perfect for this technique.

We also use some sedation when doing larger areas to limit the amount of discomfort while the fluid is being injected.  We then allow some time to pass so the fluid has time to work.  Once the local anesthetic takes hold, we start the procedure.  For most cases, we use the Cool Touch laser to break up the fatty tissue and warm the skin. 

Warming the skin promotes new collagen formation, causing the skin to contract to its new position and tightening it.

We then use hollow cannulas to remove the liquified and non liquified fatty tissue. 

This is a picture of a selection of cannulas in different sizes or diameters.  The fat is suctioned out of the body, into a cannister, and discarded. 

Once the fat is removed, it takes a few weeks for the swelling to go down and a few months for the skin to contract to its new position. 

How painful is it??  This is everyones fear of course.  For small areas, the discomfort is minimal, usually only putting in the tumescent fluid causes a minor amount.  For larger areas there is some pinching around the edges usually and this is why we use sedation.  People walk in and walk out, usually going home to rest after.  After treatment of small areas, most people can return to work the next day and for larger areas, patients return to work after a few days or a week at most.  You will be sore (like you did a very vigorous workout) for a few weeks and of course, the more you move around, the shorter the sore period is. 

What you do after consists of a few things....first, exercise.  Opinions differ but I like for patients to start stretching and massage after a week or so and resume normal exercise after about 3 weeks.  Personally, I like for patients to wear a "spanks" for a month or so after large area liposuction.

I think it really decreases discomfort and bruising.  Most people complain of an itching feeling on the skin over the treated areas as the nerves recover.  My feeling is that the compression helps this sensation as well.

That's all for this week!  Make sure you look at our liposuction offer...it is really a good one.  If you have saddle bags, fluffy inner thighs, or any other area you simply cannot get rid of, give us a call today to schedule your complimentary consultation.  Our pricing is the best. 

918-786-7780 or 1-866-weight0

LAST CALL for spring breast augmentation special pricing!!  It ends on the 30th at midnight.  You don't have to have your surgery before then, just get your quote that will be good for 60 days.  Hit this button to get all of the details.

This week, I wanted to address some of the more frequently asked questions about liposuction.  Most people have a number of questions and if you have one I don't cover, email me your question to jeffswetnam@yahoo.com and I will do my best to find an answer for you.

Liposuction, as covered last week, has really grown up over the past several years.  Used to be, lipo was done under general anesthesia, in a hospital, with significant blood loss, often requiring transfusion.  This all changed when the tumescent techniques were developed using lidocaine and epinephrine.  What this does is provide an anesthetic "block" to the area with the lidocaine (the same stuff used by the dentist to allow them to drill teeth) and limit blood loss with epinephrine as it causes constriction of blood vessels and slows the absorption of the lidocaine.  Once these techniques were perfected, liposuction pretty much moved to an office procedure.  With the addition of lasers, ultrasound, and other ancillary energy, we are now able to affect how the skin reacts to removing the underlying fatty tissue, i.e., we can make it contract and lose some of its sagginess.

Many questions remain.  One of the most often asked questions is "what happens if I gain weight after liposuction?"  To understand the answer to that question, you need to understand the reasoning behind the answer.  Theoretically, we are all born with a finite number of fat cells.  These cells increase or decrease in size as our weight goes up or down.  With liposuction, we remove a population of these cells in the area treated.  Therefore, if you gain weight, you cannot gain as much in the area treated, so, you will gain it in other places.  5-10 pounds probably will go unnoticed but 20 or 30, and you will have significant changes in other areas.  You may also notice lumpiness in the treated areas as the fat cells that are left (we cannot remove them all) will grow in size.

The second question often asked is will my skin shrink?  This is also a great question.  I look at the quality of the skin and evaluate it prior to recommending liposuction.  If the skin in the lower abdomen say, has numerous stretch marks, wrinkles and scars, then liposuction may not be the best choice as we are expecting poor quality skin to contract and smooth out. For the abdomen, in the person mentioned above, I would probably recommend a tummy tuck instead. Skin that has no stretch marks, no scars, and is good quality anyway will usually respond well.  We use the laser to promote the skin contracture and also to make the procedure less traumatic. 

The third question is usually, how much can I do at one time??  The answer to this question requires a multiple part answer.  First, how big are the areas?  We can do multiple small areas at one time.  Larger areas may have to be devided up.  Why??  Well, it depends on how much lidocaine we have to use, and, how much fat we are going to remove.  Of course, there are limits on the amount of lidocaine we can use based on a persons weight.  We also usually don't remove more than 4 liters of fat (two, 2 liter coke bottles full) at each setting as rates of complication increase exponentially when 4 liters is exceeded. I try to estimate how much fatty tissue will be removed from each area and make a plan accordingly. 

Well, that's enough for this week!  Again, if you have a question you would like addressed about liposuction, or anything else, email me and we'll do our best to address it.

Remember, Cosmetic consults are complimentary so call 918-786-7780 or 1-866-weight0 TODAY!!