Total Body Surgical Blog

Let's talk about a common problem that we can help with.....acne.  Acne vulgaris is a common problem in adolescence that can continue or leave long lasting changes through adulthood.  It most commonly occurs on the face and back but can cause problems almost anywhere.  It occurs in these places most commonly because of glands that produce a large amount of oily material.  The pores become "plugged" with this thick, oily material and bacteria (germs) get in the mix causing inflammation and pimples.  It occurs when hormonal levels are peaking, thus the high rate during adolescence but adult acne is also a common problem. 
Certainly, acne is not a life threatening condition but it can ruin self esteem and lead to life changing and permanent skin damage.  It can cause scarring and pitting of the skin that will carry through life in severe cases.  Many of us have mild and sporadic breakouts that are only a minor problem, but for some, acne is a curse that can ruin social interactions and make us very self conscious.

At Total Body Surgical we take a systematic approach to the treatment of acne.  I like to evaluate at the initial visit how severe the problem is and what potential for permanent skin damage there is.  If the problem is not severe, we start with a good skin cleanser that contains salicylic acid to remove the oil the skin is producing.  I like the clarifying cleanser made by Skinceuticals.  We also like benzoyle peroxide products for a topical kill of bacteria. Retinol or tretinoin is also used topically to help the skin turn over quicker.  This is usually our first line of treatment for even the worst cases.  For more severe problems I will add a topical antibiotic gel or start treatment with an oral antibiotic at low doses to decrease the inflammation and lower the bacteria count.  These steps will usually make the condition improve a great deal, at least enough to make it tolerable.  If not, the next step we use is the Cutera 1064 laser.  The laser genesis treatment is painless and quick with no down time.  We use the laser to gently warm the skin to a temperature  that eliminates the bacteria causing the problem.  This is usually very effective and allows the other treatments to take hold.  It is also a good way to get ready for special events...treat a week or so before and have a clear face!!  These treatments can be done at 4-6 week intervals and are very affordable.

Now for the severe cases...the dreaded Accutane!!!  I am very careful when I choose patients to use this medication.  They must be reliable and have good supervision from a parent.  The i-pledge program must be followed as well which gives good counseling about pregnancy prevention while on the medicine.  Accutane IS a great drug...it works almost universally.  It can, however, have some severe side effects that are not very common (regardless of what the lawyers on TV portray).  It can cause depression leading to suicidal thoughts, headaches that can be severe, birth defects if you become pregnant or make someone pregnant while on the drug, very dry lips and skin, dry eye....and the list goes on.  Most treatment regimens start at full dose and after clearance of the acne we switch to a lower dose program which seems to be effective.  Any of the above problems that become severe may require a stoppage of the medicine. 

I have found that most individuals will require a minimum of 6 months of Accutane and some may need more than one course of the medicine.

For those with permanent acne scarring we offer the Pearl laser.  You must be off of Accutane for a minimum of 6 months to qualify but these resurfacing treatments help tremendously to soften the scarring.  Down time is around 4-5 days and treatments can be repeated to desired effect.

If you need help with acne...give us a call at 918-786-7780...we'll be glad to give you the help you need.  Don't forget our laser hair removal...$50/treatment/area special too!!

Many questions exist about liposuction.  Most people have an image of a very violent and bloody procedure with results that are less than optimal.  Todays liposuction is much different.  Due to techniques we use today, liposuction can be done in the office, with only sedation.  I would like to address a number of questions that are commonly asked of me during a consult, and many points that I like to talk about with patients to help them understand what they are to expect. 

First, will I get fat in other areas after liposuction?  This is one of the more common questions I am asked.  The theory is that we are all born with a finite number of fat cells.  As we gain or lose weight, we do not gain or lose these cells, they just grow or shrink in size.  Some data show that in the super obese, cell numbers may actually increase but we don't liposuction these people.  During liposuction, we remove fat cells in the area we are treating.  Therefore, if someone gains weight after liposuction, it will accumulate in other areas since we have removed the fat cells in the area they have gained in before.  This is true, however, to make a significant difference, it has to be a significant amount of weight....20-30 lb.  Most people that spend the money on this type of procedure are not going to let this happen.

Second, will I get lumpy in the area of liposuction?  This can happen, especially after weight gain.  If you think about the procedure, we are removing layers of fat...not all of the fat.  Some remains.  This is a good thing.  Leaving a layer of fat below the skin allows the skin to remain smooth and supple.  Oversuction can create dents and allow the skin to scar to connective tissue underneath....both bad things.  With some live fat remaining, if you gain weight, these pockets of fat cells will increase in size and can form areas of lumpiness.  Lumps in the immediate period after liposuction are a normal thing.  Usually they are a little sore and represent areas where fat has been damaged and the body is breaking them down.  I like for people to massage these areas to speed up the process.  It can take several weeks to months for them to completely resolve.

Third, will my skin be saggy after the procedure.  This is the thing that is hardest to predict.  The things I look for are the ones that indicate skin quality before the procedure.  For example:  The stretch marks in this photo would indicate to me that a tummy tuck would be a better choice for her...why?  Her skin will have less of a chance of contracting after the fat is removed because of the poor starting skin quality.  It will be more likely than not that her skin will not contract.  This does not rule out liposuction for her but she must understand that, in clothes, she will look better and more sculpted, but in a swimming suit, the skin will still look bad and possibly more saggy.  If her skin were smooth, she would be a much better candidate.

Fourth, will the newer technologies help the final result?  Yes and no is the answer.  Laser and ultrasound technology have helped but they are not the silver bullet.  I like to use them as an adjunct to traditional liposuction.  The idea is that heating the skin from the inside does cause some contraction, how much is the unknown.  I remove the fat first then use the laser to heat the skin to allow skin contraction.  Several studies have been done that indicate the use of these technologies alone are sub-optimal and my experience verifies this.

We do liposuction often and combine it with many procedures.  It is a great procedure and helps a lot of people.  We do the procedure in the office with sedation and tumescent solution.  This solution contains lidocaine that numbs the area and also epinephrine that causes the small blood vessels to contract and limits blood loss.  Patients recover quickly and this depends on the size of the treatment area.  It takes the skin several months to contract and heal so the final result is seen after 3-4 months.

Come see us for a consult and for a limited time receive 10% off of the procedure.  Don't forget our laser and breast offers too!!!!

918-786-7780

Laser days at Total Body Surgical!!!!  We know have the Cutera laser full time in Grove...VERY exciting.  The Cutera laser is one of the most comprehensive lasers, IPL combinations on the market.  The system can nearly do it all, and do it well.  I have many years of experience using this system and it is great at treating a large number of problems.  Let's itemize them:

1.  Laser hair removal.  With the Cutera system we use the ProWave 770.  It is an IPL (intense pulsed light) that can treat large areas and do it very effectively.  In a pinch for smaller areas that are difficult, we have the 1064 YAG which most of the older systems are based on.  Laser hair removal is very popular and has, in the past, been cost prohibitive.  For a limited time, we are offering an exceptional deal...$50.00 per area per treatment.  This will be good through the summer so don't miss it.  Usually facial hair takes about 9 treatments and body hair 6.  This means you can get your underarms done for $300.00.  Take advantage of a great value!

2.  Facial or body dyschromias.  Age spots and redness become a problem as our skin ages.  The IPL Limelight system is great for treating a variety of discolorations on the face, arms, and hands.  This usually requires a series of 3-5 treatments and we usually like to have you on the Obagi skin care system to prevent further damage or recurrence.

3.  Facial veins.  We use the 1064 YAG to treat small viens that occur at the base of the nose, on the cheeks and chin.  The laser targets the pigment and closes the vein, removing it on a permanent basis. 

4.  Leg veins.  We use the 1064 YAG to treat small areas of leg spider veins as well.  For larger areas we usually inject with a sclerosant.

5.  Laser skin resurfacing.  We have the Pearl laser for resurfacing.  This helps with reducing pore size, improving skin color, fine lines, and wrinkles.  The great thing about the pearl is the short recovery time and similar results to the CO2 laser.  Recovery times are about 4 days with great results.  Some may require a series of 2-3 treatments about 2 months apart.

6.  Laser treatment of Hemangiomas or cherry spots on the body or face.  These require only one treatment in most cases and they are eradicated.

7.  Laser Genesis for treatment of acne, to reduce pore size and improve skin tone and texture.  This works exceptionally well with no down time.

8.  Titan treatments for skin laxity in the neck and face using Radio Frequency with no down time.

We are very proud to have such great technology in Grove.  Our pricing is unbeatable and results are outstanding.  Our nurses, Janet and Trish are very skilled at suggestions and advice and are very good at treatments.  We also have the Zimmer system that provides comfort during treatment sessions.  

Come see us soon to arrange YOUR treatment plan and schedule.  Call 918-786-7780 to arrange today.

Breast disease for men???  What the heck you say.  Well, it does happen even though breast problems and Cosmetic breast surgery IS much more common for women. What kind of problems would a guy have is a question you might ask.  Well, there are several, but today I want to address a problem called gynecomastia.  Gynecomastia is a word that means puffy nipples.  Gynecomastia normally occurs during hormonal changes in the life of infants, adolescents, and men.  The first time in life it occurs is in infancy.  After birth, estrogen from the mother is high in the infant and breast tissue develops that rapidly disappears.  It also occurs in elderly males as the hormonal changes of aging take hold.  Many medications can also cause the breast tissue to increase.  Other causes are beyond the scope of this installment.  I mostly want to focus on the adolescent occurrence.  In adolescent males, gynecomastia can develop in as high as 80% of individuals.  Again, its the hormones that occur normally and in those who use anabolic steroids.  Unfortunately, in up to 30%, it doesn't go away this time.  Gynecomastia during adolescence is made of fatty tissue with a bud of breast tissue under the nipple.  By the early 20's it should be gone, if not, it may become a real problem.  The problems it causes are not generally physical but psychological.  Wearing normal clothing becomes an uncomfortable situation for a guy that has breast tissue and makes one very self conscious.  Working out to develop pectoral muscles can often times only make things worse...so what's a guy to do??  First of all, be patient.  It is hard to do but fortunately, in a majority of cases the problem resolves after hormone changes settle down.  In cases that don't resolve, we can take care of the problem.  Usually, in the normal case, I will liposuction the chest and remove the "bud" of breast tissue.  I do this through a small incision in the arm pit to liposuction the chest of excess fatty tissue.  I then make an incision through the nipple to remove the small bud of breast tissue.  We do this in the office procedure room using some IV sedation and tumescent local.  It takes less than an hour and can be life changing.  We have you wear a compression shirt for about 3 weeks and from that point on, normal clothes can be worn without the worry of those two little reminders poking through.  The incisions heal very well and go unnoticed after a healing time of a few months.

If you or someone you know has this problem, come see us!  We can help.  Call 918-786-7780 for an appointment.  Don't forget our other specials as well...laser hair removal, breast augmentation, nail fungus eradication, and great pricing on Obagi skin care products.

Is it possible to have a lift and augmentation at the same time?  This is a question I am asked all the time.  There are many cosmetic surgeons that feel a simultaneous procedure is not possible.  Others feel it is not safe and should not be done.  In the recent issue of Cosmetic Surgery Times, the lead article and most of the discussion was centered on this question.  In my opinion, there are very few instances when they cannot be done together. 

Why would you not want to do them both at the same time?  Good question!  The reason is multi-faceted.  First, the lift.  When we do a lift or reduction we are doing a number of things to the breast.  We are, most importantly, repositioning the nipple to a more youthful and appropriate position.  As the breast ages and is used for nursing, it looses its support and begins to sag.  The nipple falls below the fold under the breast and the upper part of the chest takes on the shape of a ski slope. We can lift the breast in this instance but it will not make the upper part of the chest full.  Once the nipple has been repositioned into a more appropriate spot, we have all the skin left below it.  This skin must be removed and the skin envelope tightened.  We now have a breast that is much perkier with a nipple position that is elevated. As you can see, there is a great improvement in shape and nipple position.  However, from this 45 degree view, the upper aspect of the breast is very sloped.  Many women don't mind this and that is fine but if upper breast fullness is desired an augmentation is required with an implant.  That's where the problem comes in.  The second problem is this; now that we have a tighter breast skin envelope we are now going to place an implant that will stretch what we have now tightened.  This can easily be done and since we have lifted the nipple we put the implant below the muscle.  What this does is fill in the upper pole of the breast and helps you regain that youthful breast that was lost.As you can see from the picture, on the lateral view and 45 degree view the upper pole is now full with good cleavage...nice result.

The third problem...do it twice and make it as identical as possible!!

That is why doing a combined lift with augmentation is challenging to many Cosmetic Surgeons.  At Total Body Surgical we do them daily with great results.  This procedure can make a tremendous change in how you look in clothes and out of them.  Come see us today for a complimentary consultation...call 918-786-7780.  Don't forget our other procedures that we have special pricing on...liposuction, breast augmentation, laser hair removal and many others.

Like us and be our friend on facebook too....please!!

I guess the test last week was not so good judging from the response.  A few people really loved it so I may consider doing another in a few months....maybe on breasts...lift vs augmentation alone....or....faces, mini vs. full face lift....we'll see.

Today I want to discuss the Pearl laser.  Lasers have come a long way in the past 10 years.  We have gone from a technology looking for a procedure to actually being able to make a huge difference in a number of skin issues.  The great thing is that recovery times and safety have jumped in leaps and bounds. 

There are many reasons to choose laser skin resurfacing.  What resurfacing can do is:

1.  Reduce facial skin discolorations such as brown "age spots" and other discolorations.  These are caused by sun damage and age.

2.  Reduce fine lines and wrinkles in the face, neck, under the eyes, and crows feet.

3.  Shrink pores that are enlarged.

4.  Improve acne scarring.

5.  Improve skin color and texture.

6.  Improve vertical lip lines.

Why the Pearl??  The Pearl laser is fairly new technology that is similar to the CO2 laser.  What makes it good?  There are a number of reasons the pearl is superior.  First is recovery time.  The recovery time from the average treatment is only about 4 days.  This means that new skin reforms quickly, much quicker than the CO2.  Second is cost.  The cost of the Pearl treatment is $1200.  Compared to the CO2 this is less than half.  Third, you don't need general anesthesia.  We usually do the procedure with some mild oral sedation and topical anesthesia. 

The Pearl is made by Cutera..hit this link for more technical information.  Here is also a video from The Doctors that talks more about it.

www.youtube.com/watch?v=8OBi5AcQwWQ

Come see us and you won't be sorry....your youthful skin awaits.

Today I am going to give you a test.  Fun, huh!!  No grades will be given, thank you.  Hopefully you can learn something from this and if you like it, let me know here and I will come up with some similar ones for other common procedures.

Today the test is going to be about liposuction and tummy tucks....when is one appropriate and not the other and vice versa. Good luck!!

#1.  ....what do you think??  Tummy tuck or lipo?

  We start with an easy one.  If you said tummy tuck, you would be right.  There is no doubt there is a lot of fatty tissue present and liposuction COULD be considered, however, the hanging skin would only become worse.  A tummy tuck with associated liposuction of the waist would be the appropriate choice.  The tummy tuck would remove the excess skin and stretch marks below the belly button and liposuction of the waist would accent and renew the shape of the sides of the abdomen.

#2.  Which is it, tummy tuck or liposuction?

  This one is a little tougher.  When you look at this abdomen what do you see?  As far as fatty tissue goes, there is only a problem area in the mid abdomen and a lower abdominal pooch.  Normally, this would be a perfect abdomen for liposuction, however, you always must evaluate the skin quality too.  The skin in the lower abdomen is riddled with stretch marks.  For this reason, I would recommend a tummy tuck.  The tummy tuck removes a majority of the stretch marks, tightens the remaining ones and moves them below the pant and swim suit line.  Of course if she presented not caring about skin quality after the procedure, a liposuction procedure could be selected.  I would doubt the level of satisfaction after liposuction alone.

#3.  Which one??

  Not exactly a clinical photo, but, it makes a point.  This girl is the perfect example for liposuction.  Perfect skin, nice shape overall, and just a small area of fat in the lower and mid abdomen....what a pallet!!  I could make this abdomen look amazing.  I would use a small cannula, remove the fatty tissue and give her some definition.  I would then use the cool touch laser to tighten the skin more.  It would look fantastic.

#4.  The last one...Tummy tuck or lipo....this one is a little tough so take your time!

  This abdomen is a little tougher.  The skin looks pretty good.  The shape is fair with some fatty pockets that could easily be removed with liposuction.  Liposuctioning the waist would also improve her shape into a more hourglass look.  BUT, what about the C-section scar?  It is a point of adherence that liposuction will not address.  I would recommend a mini tummy tuck with liposuction.  This would allow me to tighten the lower abdominal skin, remove the C-section scar, and liposuction the waist.  I would not make an incision around the belly button but remove some skin that will make it look better.

Good job!  I hope you enjoyed our little quiz.  Remember to let me know on facebook, twitter @jeffswetnam, or here if you like it.  I can come up with some more I think you will like.

Here are a couple of pictures of my work....

Don't forget our laser hair removal special...$50.00/treatment/area...amazing.  Also, our breast augmentation special for silicone and saline.  Lap band specials as well.

Welcome to Trish, our new RN.  An amazing girl that we are very proud to add to our Total Body Surgical Staff.

What is IPL?  It is a great way to remove unwanted discoloration or dyschromias on the face, chest, hands...anywhere on the body.  It is the use of Intense Pulsed Light or a flash lamp to influence the pigment cells in the skin. 

How it works is by using a specific wave length of light that targets certain color in the skin.  The color we usually are after is brown.  Age spots, liver spots, whatever you want to call them, are a problem caused by skin aging and sun damage.  They are present on sun exposed parts of the body.  The IPL is absorbed by these brown areas that then peel off and are gone.  The melanocyte (the pigment cells in the skin) is encouraged to turn off and when the skin is then protected from future sun exposure, they usually stay away.

  (melasma or brown spots from the sun)

We like to combine good quality skin care with Obagi products to speed up the effects of IPL and make them longer lasting.  The Tretinoin and hydroquinone causes the skin to grow faster and the hydroquinone turns the melanocyte off.  The IPL gets rid of the current brown spots and voila your skin begins to look like it did before the sun and baby oil did its damage!!!

Red spots on the skin can be caused from sun damage as well.  Also causing the problem are small blood vessels in the skin.  To treat these areas the wave length is different but the process is the same.  The small blood vessels are injured by the light, closed, and the vessels are broken down by the healing process.  The red areas are removed.

Usually, IPL treatments are done in a series of 3-5 treatments.  Once problem areas are gone, protection from the sun is the key to long term success.  

A treatment consists of about a 20-30 minute application of a numbing compound.  We wash that off and the actual treatment takes only a few minutes.  Hands can be treated as well and most want the decollatage or chest area treated too. 

We use the Cutera XEO system which allows us to use multiple wave lengths or combine wave lengths in a single treatment.  At Total Body Surgical we charge $150 per treatment and we have special pricing for packages of multiple treatments which is usually required.

Don't forget our breast augmentation specials on silicone and saline AND we are having great success treating nail fungus with the laser.  Our lunch time lipo special is still running also and our laser hair removal at $50.00/treatment/area can't be beat!  We have people driving from Memphis, Tn because we are so cheap!!

Call today for a consultation..918-786-7780.

Everyone wants to know about silicone implants so I decided to talk about them this week.  Silicone implants were the first mainstream implants for breasts available to the US market.  They were used for years and for the most part, the results were good.  Most were placed above the muscle through a variety of approaches.  However, there were design flaws in the implants themselves that led to a number of suits and settlements that actually put a few manufacturers out of business.  The suits claimed that a number of illnesses (cancers, fibromyalgias, lupus, and many other problems) were caused by the silicone.  The fact is, the more liquid silicone in the old style implants leached out over time through the capsule.  This silicone was picked up in the lymphatic system and traveled into lymph nodes and other areas of the body.  Because of litigation and fear, the FDA removed the implants from the market in the early 90's.  The FDA authorized several companies to perfect and study silicone implants at that time. 

Improvements that were made were basically to the capsule holding the silicone and to the silicone itself.  The silicone was heavily cross linked to create a jelly-like substance that likes to stick together.  When a hole is poked into the implant, the silicone does not flow out like liquid.  It takes a fair amount of pressure on the implant to extrude the silicone.  The implant can actually be cut in half....the video I made below demonstrates this.

http://youtu.be/kceaEMmi7pA

The benefits of silicone are somewhat subjective.  First, they are perceived by some to feel "more natural".  Second, they have a tendency to ripple less.  A photo of rippling is below.  Although rippling can happen with silicone, it occurs less frequently.  Silicone is a lower pressure implant and that is why.  Because of this lower pressure, the upper pole is not quite as full as with saline and can look less like an implant.

The down side to silicone implants is expense.  They do cost more...about $1200.  The incidence of capsular contracture (when the capsule the body makes around the implant becomes tight and makes the implant feel hard) is higher...not a lot higher, but higher.  Women under 22 years of age do not qualify for silicone because of FDA rules.  If they do rupture, it can be difficult to detect and the FDA recommends periodic MRI of the breast for detection, however, even MRI is not that great. 

Watch this video where I cut a new silicone gel implant in half.  You can see the properties of the silicone.

I personally have no preference between silicone and saline.  I do not like high profile saline  implants because the look is not appealing.  If someone wants implants under the breast instead of under the muscle, I recommend silicone.  Otherwise I think they are interchangeable.

Hope this answers a few questions for you.  Don't forget our specials on implants for this spring.  We have great pricing that is hard to beat...call us at 918-786-7780 for details.  We also have pricing on laser hair removal that I defy anyone to beat....$50 per treatment per area....wow!!

Talk next week!!

Last week we talked about eyes, the window to the soul.  Today we are going to discuss another part of the anatomy that can instantly tell your age.

Youthful lips are generally very full and inviting.  They are made of the white line where the skin and the pink mucosa of the lip join and the fullness of the lip takes off.  The cupids bow is in the center of the upper lip giving definition and contrast that the lower lip is missing.  Usually the lower lip is slightly larger than the upper.  Youthful lips are smooth and surrounded by skin that is also smooth with uniform color and texture.

  So what happened??  A number of things.  Skin aging, sun damage, volume loss, i.e. fat, around and in the lip, smoking, using straws, smiling, frowning, kissing and just time.  All of these things age our entire face but since the mouth is one of the centers of motion and expression in the face, like the eyes, it shows the use as we age.  The lips become thin and surrounded by vertical lines, nasolabial folds, marrionette lines.  The "white line" becomes less visible and the "cupids bow" becomes a straight line.

How can we repair the damage??  We can lift the tissue around the lips, correcting the cheeks and neck.  We can correct the nasolabial folds by adding volume in the form of a filler (Juvederm, Radiesse, fat grafting).  We can do dental correction to improve the underlying structure if needed.  To correct the skin damage, it is important to improve the skin.  We can do this in a few steps.  First, good skin care is critical.  As stated here before, we recommend Obagi products that combine Tretinoin and hydroquinone to correct color changes and improve the texture of the skin.  We then can augment the lips using temporary fillers like Juvederm or more permanent fillers like Silikon 1000.  This replaces the volume that has been lost.  Lastly, after pre-treating the skin with Obagi and repairing sun damage, the deeper wrinkles and vertical lines remain.  What to do about them?  They can be filled if extremely deep, again, with a temporary filler.  The best way to treat the area is with laser.  Resurfacing the area promotes new collagen production, softens the wrinkled areas, and removes the sallow color of the skin.  I usually recommend doing the entire face along with the area around the mouth.  This removes transition zones and looks more uniform.  We use the Pearl laser which is great for this.  It has a faster recovery time than similar lasers, can be spread over multiple treatments, and gives great results.  The price for the first treatment is only $1000 and repeat treatments are $500.  Most require 2 or 3 treatments for a great outcome.  The order should be, skin care, laser, then filler as some laser treatments can degrade the filler material.

Come see us for lip rejuvenation.  We carry a complete line of Obaji products and fillers.  Also Botox that can help prevent some of these changes.

Don't forget our other specials too....summer is approaching rapidly!!  Breast augmentation starting at $3799.00!