Total Body Surgical Blog

                                                                                      Let's talk about eyelids for a bit.  As the old Yiddish proberb says, "the eyes are the mirror of the soul"....eyes are very important.  When we meet someone, where is the first place most people look??? the eyes.  Therefore, if we have prematurely aging eyes, they can make us look older, more tired, and cover one of the most beautiful attributes we all have.  Eyelids, though small, can change even the way we think about ourselves.  We look in the mirror and even though we don't feel tired because of the "tiredness" we see in our eyes we begin to reflect it in our actions.

Youthful eyes are wide and inviting.  The upper lid is full with few wrinkles and no excess skin present.  The lower lids are smooth with skin color that is pink.  There are no bulges, folds, or "bags" to draw our attention from the color of the iris or the pupil.  We see well as there is no abstructing skin in the way.  We look and feel great.

As the instoppable aging proces happens, eyes, are at times, the first thing to reflect it.

  Why is this?  When did it happen?  How did the first picture become the second??  Well, let's get some answers.  The eyelid skin is some of the thinnest skin on the body.  It also moves more than the other skin and it is constantly exposed to the damaging UV rays of the sun.  The other thing that happens is a loss of fatty tissue in the face.  This exposes underlying connective tissue where it is tethered to bone.  Lines and bulges that are normally window shaded by ample fat pads begin showing up when those fat pads diminish.  Fine lines and wrinkles develope from sun damaged skin, motion, and sagging of the muscle around the eye.  The process is unrelenting and over time, the sagging skin can even decrease vision.

  What we see here is a large amount of extra skin on the upper lid obstructing vision and the fat pad below the eye is protruding with severe skin changes.  Regardless of actual age, these changes can create the image of a very old person and the view of the eye is just a slit...not a very good view of the soul.

At Total body surgical we do a lot of eye rejuvenation.  It is one of the more rejuvenating procedures we do.  It is fairly simple and can take years off.  Upper lids are done with some light sedation and local anesthesia.  Lower lids can also be done with light sedation sculpturing the fat pad and either removing the loose skin or lasering it to tighten it up.  We often graft fat into the cheek to restore a more youthful look.  Recovery time for upper lids alone is quick, usually about a week and for lower lids a week or two depending on laser use.  We have great pricing on lids so be sure to check us out!  Cosmetic consultations are complimentary so call 918-786-7780 for a visit.  Also remember our other offers on the lap band, breast augmentation, hair removal, and liposuction.  Summer is right around the corner, so get ready now!!!

I have seen many discussions on message boards about how to manage hyperpigmentation.  Some of the advice is good and some not so good.  First of all, what is hyperpigmentation and why do we get it??  Pigment issues are very common.  The causes are numerous but the primary cause is the sun.  When we are young and invincible we worship the sun throwing care to the wind.  This is especially true for my generation.  Oils and iodine were the staples of sun worshippers.  Nobody had heard of sun screens and everyone burned.  Now we deal with those transgressions fighting skin damage and discolorations (dyschromias).

AGE SPOTS (liver spots)

How does the sun cause pigment issues?  UV light from the sun causes the skin to protect itself by producing brown pigment or melanin.  Melanin comes from melanocytes.  People of color who originate from sunnier areas of the world produce this naturally and have darker skin.  Caucasians have to rev up the melanocyte with UV exposure.  UV light used to be from the sun but now the sun is rivaled by tanning beds and tanning goes on even in winter.  What happens is the melanocyte is started up and over numerous exposures, it doesn't stop.  This creates areas of hyper(too much)pigmentation.  Other causes are pregnancy (hormones) that lead to the "mask of pregnancy" otherwise known as melasma.  Trauma (acne scarring) especially in ethnic skin can cause dark areas.  There are also many other metabolic diseases that can lead to the problem.  ACNE DYSCHROMIAS

So what do you do about these areas.  On the sites I have been reading there are many suggestions from herbs to topical creams.  Let me tell you how I deal with dyschromias.  Since these areas are significant and are due to long term damage, they need significant therapy to heal the skin.  That means OBAGI.  The Obagi skin care system is a medical grade collection of products that heal the skin and correct the underlying damage.  MELASMA

Obagi products were developed by a dermatologist Dr. Obagi.  They are based on Tretinoin which is a cousin of Retinol and causes the skin to turn over faster making it look healthier.  The other compound is hydroquinone.  This is a compound that turns the melanocyte off decreasing the amount of pigment produced.  Also there is sunscreen to prevent future damage.  After starting the treatment with Obagi we recommend IPL treatments with the Cutera Limelight to remove the pigment that is present now.  IPL treatments target the color present in the skin and using a flash lamp the pigment is shot with bright light to break it up.  The body then absorbs it and with the hydroquinone and Tretinoin stopping the production of more pigment, it can be controlled from now on.  Protecting the skin from further UV exposure with sunscreen and maintenance Obagi keeps it away.

Come by or call 918-786-7780 for Obagi or Skinceutical products.  We can ship from our office.

Now is the time!!!  Time for what you ask??  Time to get a jump on summer!

There is a lot that can be done to get ready for a new look this summer.  Probably the biggest thing (no pun intended) is a breast augmentation.  Many women think about doing this when summer is already here.  Then, it is too late in many cases to enjoy them.  It does take a few weeks to recover and regain normal activity.  So in reality, now is the time.  Do it in the winter, recover in the winter, and unveil in the spring and summer.  Spending time at the pool or lake in your new suit with new assets will be great fun for you after an augmentation. 

Whether you want saline implants or silicone gel implants, we, at Total Body Surgical can take care of your needs.  We are here to please.  I will personally listen to your desires, we will discuss the pros and cons of different implants, placement options, and especially sizes.  Most women are worried that I will choose the size and you will be stuck with it.  At our facility I will give you a range of sizes based on your measurements and we will try them on in your clothes and YOU decide so you can get the look you want.  Our special pricing for this summer is $3899.00 for saline implants and $5099.00 for silicone implants.  This includes all fees with the exception of medications that you will get from the pharmacy.  It includes the pre op and all post op care. 

The other big thing we have discussed recently that can make a huge difference is liposuction.  Many women have small areas (hips, thighs, saddle bags) that are unsightly.  These areas are difficult to get rid of even is you are in great shape and exercise regularly.  This is when liposuction shines!  For small areas we can do them in the office with or without sedation and it is very affordable.  Recovery time for a single small area is very short (a weekend or so) and when using the laser the skin contracts well over the next few weeks and looks great.

Our pricing for liposuction is fantastic and we have bookings available now.  As summer approaches, spring break, etc. get closer, the operating times get tight. 

Come now and get these special prices and book your time before it is gone!!

Don't forget our amazing hair removal offer as well!  Just $50. per treatment (an average of $300 per area).

"Hairless summer".....do you want one??  No shaving, no creams, no embarrassing moments at the pool or beach, no rashes.....NO problem!

Most women (and men) have hair they don't want.  It is a constant issue we all deal with.  With summer approaching, NOW is the time to start the process of hair removal.  How would you like to wake up and not worry about underarm hair, leg hair, bikini hair, back hair or any hair in a place you have to groom over and over again.  I want to assure you that we, at Total Body Surgical, have the best and latest technology to reduce hair in all areas at prices never before seen in the region.  

We have talked about hair removal and how it works in the past but a review is in order.  Laser hair removal has been around for some time and is very effective when in the right hands.  It works by killing the hair stem cells that create the hair from the follicle.  This image shows how the dark hair absorbs the laser energy and carries it to the hair creating cells in the follicle and eliminates them.  Through this process, the hair becomes thinner, lighter, and in most cases, is eliminated all together.  We can treat hair anywhere on the body with excellent success.  In most cases it requires an average of 6 treatments for body hair and 9 treatments for facial hair.  The treatments are usually spaced about 4-6 weeks apart to allow the hair to be treated in its different stages of growth.  Due to new hair follicle development during life, some people may require "touch up" treatments in the future, maybe a couple of times every few years.  Laser technologies do not work well on blond, white, or gray hair.

At Total Body Surgical we have the latest IPL and Laser hair removal technology.  Using the Cutera 1064 YAG laser and the Pro Wave 770 IPL we can treat most areas quickly and with minimal discomfort. 

Why are we different than all the other places??  In the past, laser hair removal was very expensive.  The technology is not what most would call cheap.  This equipment can cost several hundreds of thousands of dollars and treatments for larger areas can cost thousands.  At Total Body Surgical we realize that removing unwanted hair applies to all of us and not only the wealthy.  Therefore, we have concentrated on reducing our prices to rock bottom.  We are offering hair removal for $50.00 per treatment per area.  This means that you can have hair removed from an area...let's say underarms....that's an average of $300 for 6 treatments.  Bikini area.....$300.  Both areas.....$600.  This is an outstanding deal that is not a special, it is our usual pricing and it's hundreds less than most providers.  It is worth the trip to Grove and the lake to have this done and can be life changing in time savings and removing the stress of unwanted hair growth.

Come see us soon, and don't forget our other special prices!!!

Let's talk about liposuction ....again.  If you didn't see this spot on the 40/29 Fayetteville, Arkansas news, have a look!

http://www.4029tv.com/news/30406524/detail.html

Remember "smart lipo"??  Well, it is still around but there have been improvements.  Smart lipo is when a laser is used to destroy fat cells in problem areas.  It has been touted as being less traumatic and with faster recovery times.  It became available in 2007 and was all the rage for awhile.  I was in my cosmetic training at the time and we were the first ones in Oklahoma to have a machine and we taught courses on how to use it for Cynosure, the manufacturer.  The idea was that the laser energy destroyed the fat cell and the remains were resorbed by the body.  The skin would contract and you would have a new contour.  What we found (and what many studies have shown) is the results were not as good as traditional liposuction because the volume of fat destroyed and removed was not adequate.  What has been shown is that the heat generated by the laser does cause the skin to contract better than with traditional methods.  The take home message is this...liposuction is best for removal of fat and contouring the body.....the laser energy works to heat the skin and cause it to contract to its new position.

So what is "lunch time" lipo??  It is combining liposuction, laser liposuction, and tumescent anesthesia to treat small problem areas without sedation or other anesthesia.  The key word is SMALL.  We all know, through intuition, that a procedure that involves treating a large area or multiple areas cannot be done without some recovery time AND for larger areas we sedate you for comfort and to make it a good experience.

At Total Body Surgical our Laser liposuction is done a little differently.  I use the CoolTouch laser that has a slightly different wavelength, the major difference is the cannula we use.  With traditional liposuction the fat is removed with a hollow cannula.  If the Smart Lipo is used, the laser cannula is then used to heat up the skin causing contracture of the skin.  With our machine the cannula is combined.  This allows me to liposuction and laser simultaneously, saving time with better results.

Come see us for a complimentary consultation and I will cover options with you.  What is a "small area" that would qualify for the lunch time procedure??  It would be a single area such as the neck, saddle bags, inner thighs, lower abdomen, hips.  You would arrive at the office and we would mark the problem area in question.  We would numb the area with tumescent solution and make a small incision in the skin.  The cannula is inserted and the laser turned on.  The fat is removed and the skin heated simultaneously.  You may drain from the areas for about 12 hours and we would want you to wear a "spanks" garment for 3-4 weeks.  You may have some bruising and some minor discomfort for a few days.  Please see my portfolio page to see some pictures of my patients before and after photos.  See our lipo specials too...we have great deals for the spring. 

Colonoscopy....ugggg!  Why do we need one?  Well, it is fairly simple.  First of all, what is a colonoscopy?  It is the examination of the inside of the colon with a flexible scope.  What is it for?  It is to discover any abnormalities in the mucosa or lining of the colon that may be harmful, the biggest being colon cancers.  According to the National Cancer Institute....

Definition of colon cancer: Cancer that forms in the tissues of the colon (the longest part of the large intestine). Most colon cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).  Estimated new cases and deaths from colon and rectal cancer in the United States in 2012:

	New cases: 103,170 (colon); 40,290 (rectal)
	Deaths: 51,690 (colon and rectal combined)

These are pretty big numbers.  Kind of scary!  What can we do about it?  Well, lets talk about colon cancer a bit.  It develops from the lining of the colon.  It can have genetic causes but also most frequently occurs without aa direct genetic component.  It is usually from the glandular structures in the colon, thus called an adenocarcinoma.  The most common age of occurrence is in the mid sixties.  It develops from polyps in the colon, if left unchecked grow and can become malignant.

 This picture represents a small polyp that is non malignant.  If left unchecked the small polyp above can become the large cancer that you see here.

  This picture illustrates the presumed progression of polyps from a small benign problem to a cancer.  Of course polyps are not the only thing we look for.  Inflammatory bowel disease and other problems are also detected with this test.

Now that you are hopefully convinced that colon cancer can be prevented by screening and therapeutic colonoscopy..why doesn't everyone have it done?  Mostly fear is my perception.

This is not a part of our bodies that we like to show people for one thing and most people think it will be a painful affair.  Let me tell you, it is not.  The worst part of the whole ordeal is getting ready for it and the prep regimens we use today are good and getting better all of the time.  Most people use sedation during the test so you basically feel nothing.

So if you are having colon symptoms of any type or are 50 or older, go get your scope done.  It is not that big a deal and it will give you peace of mind. 

Check out this link....TV news spot from Fayetteville, Arkansas about our liposuction procedures... http://www.4029tv.com/news/30406524/detail.html

Remember our specials too!!

GERD.....Sounds like something bad doesn't it??  GERD is an abbreviation for gastroesohageal reflux disease.  It describes a number of symptoms and issues that can occur when the esophagus becomes irritated by stomach acid when it spills back into the esophagus.  As we all know, the stomach is the holding chamber for what we eat.  It produces acid and is able to churn the food, acid, and mucous together to begin the process of digestion.  The stomach is protected from the acid by the mucous that it produces.  The way the food gets from the mouth to the stomach is through the esophagus.  The esophagus is a tubular structure that is covered with cells that are not capable of protecting themselves from acid.  Where the stomach and esophagus come together is called the esophago-gastric junction (EG junction).  This is where the esphagus leaves the chest and enters the abdomen.  It is supposed to be an area of higher pressure and an angle that prevents reflux of stomach contents from the stomach into the esophagus.  This image may help you understand.....

Reflux can happen to all of us.  The symptom of the problem is "heart burn".  Belching stomach contents into the esophagus exposes the lining of the esophagus to acid causing discomfort and at times, severe pain that can be severe enough to be mistaken for a heart attack. 

For most of us, this is an infrequent event and we take a Tums and it is just a bad memory.  For others, it can become a daily problem that alters their life.  Often, it is associated with a hiatal hernia.  This is a widening of the hole in the diaphragm where the esophagus leaves the chest.To treat this problem, in most cases, there are medications that can control it.  Many times, medication can eliminate the symptoms and make the problem manageable.  If not controlled, some may develope scar tissue that can lead to stricture.  Others can have cellular changes that can increase cancer risk...it is a problem that should not be ignored. 

What happens if medications don't work??  GERD and hiatal hernia can be treated surgically.  When treated this way, the problem is usually cured.  The procedure we use is called a fundoplication.  We tighten the opening in the diaphragm then wrap the upper part of the stomach around itself to re-create the angle at the end of the esophagus stopping the reflux.

  I do the procedure laparoscopically with five small incisions.  In rare cases it may require open surgery.

  Hospital stay for this procedure is a couple of days and recovery time is fairly short.

Hopefully this will give you some insight into a common disease, how to treat it medically and surgically.  See your Doctor for treatment and if you need a surgical option....come see us at Total Body Surgical where we can help.

It hurts when I eat!!!  This is a common complaint I hear almost daily.  As you know, at Total Body Surgical, we not only take care of Cosmetic Surgery patients, Vein patients, and obesity problems but General Surgical problems too.  Many times, procedures can be combined to tackle two problems at once. 

Abdominal pain comes in all forms and everyone experiences it differently.  Pain in the right side of the abdomen under the ribs is a very common problem.  This type of pain is usually the indicator of a failing gallbladder.  It starts with pain after fatty foods but may advance to pain after any food.  This pain may be felt in the back, usually at the tip of the shoulder blade.  It may also present as indigestion.  The pain usually starts as mild discomfort but as time goes on, it becomes more severe with spells becoming closer and closer together.  It may be associated with nausea and vomiting as well as changes in bowel activity.

What is a gallbladder???? 

The gallbladder is a small, pear shaped organ at the base of the liver seen in the picture above. What does it do??  It is a small storage depot for bile.  What is bile?  Bile is a salt in solution that is formed and recirculated by the biliary system in the liver.  What does it do?  Bile is a solution that helps us digest and absorb dietary fat.  Without it, fat just sails on through the digestive system and causes diarrhea.  With it, the fat is emulsified and absorbed to use for energy.  When a meal is eaten that contains fat, the normal gallbladder is stimulated to release a bolus of bile into the intestine.  The bile mixes with the fat and it is digested and absorbed.  What goes wrong to cause pain and gallstones? Pain is caused when the gallbladder is stimulated and it cannot contract properly.  This causes a cramping type of pain (colic) in the right upper abdomen, back, etc.  Bile is a salt in solution.  If you take a jar and put salt and water in it, mix it up and keep it moving, the salt stays mixed in the water.  If you stop the mixing, it can settle and form crystals at the bottom of the jar and if you roll those crystals around they can come together to form larger crystals or stones.  This is what happens to the gallbladder.  It loses its ability to release the bile when stimulated and the bile salt comes out of solution and eventually the crystals form gallstones.  The stones are a symptom of the real problem....the gallbladder itself. 

Once the symptoms become severe enough, most people will seek medical attention.  The diagnosis is made with some fairly simple tests.  First, the ultrasound.  This is a simple and pain free test to detect stones.  If stones are present and you are having symptoms the gallbladder should be removed....more about that in a minute.   If the ultrasound is negative and the symptoms are convincing, usually a HIDA scan is ordered.  This test is done to see how the gallbladder is working.  It involves an injection to fill and then another to stimulate it to work.  If it does not eject its bile normally, it should be removed.

Today the gallbladder is almost exclusively removed using a laparoscope.  This is usually an out patient procedure done through small incisions and recovery is pretty quick.  Incision placement is pretty standard... Here is a picture of gallstones....not too pretty.

  We can live normally without a gallbladder in most cases, especially a sick one.  Some people may experience a little diarrhea that usually resolves but most importantly, the pain is gone.  If the disease is not treated, the stones can escape the gallbladder and get into the duct causing bigger problems that we won't discuss here.  The gallbladder can also become infected which can be an emergency.

This procedure can also be combined with a tummy tuck when done electively.  The incisions are not made through the skin but under it so nobody will ever know....pretty cool!

Come see us at Total body surgical Cosmetic and Vein Clinic where we can discuss General surgical, Cosmetic, Vein, and Obesity issues.  Don't forget our special pricing AND keep an eye out for our soon to be announced spring roll out!

Speaking of bulges....This week we are going to shift gears a little and talk about some General surgery.  When we look at the abdomen and see something bulging, it usually means there is a hernia present.  Hernias are a very common problem.  Many people are born with them.  The most common places for this type of hernia is in the groin area (usually in men) or in the belly button or umbilicus.  These areas are where natural weaknesses are present from either the umbilical chord or where the testicles descend.  Other hernias that can form present themselves in the mid line of the abdomen or more commonly in incisions from other surgeries. 

What exactly is a hernia??  Our abdominal wall is composed of layers of muscle and connective tissue.  The connective tissue looks like a thin tendon.  All of us who have cut up meat or a chicken have noticed the shiney layer of whitish, tough tissue that surrounds the muscles....this is connective tissue or fascia.  Pound for pound it is very tough and it is responsible for holding in the contents of the abdomen and gives the muscles something to pull on when they contract.  A hernia occurs when there is a hole created in this layer and contents of the abdomen poke through that hole.  The mid line of the abdomen (especially the belly button) and the groins are the weakest areas and therefore are the most common sites for naturally occuring hernias.  Here is a picture of an inguinal hernia...

Here is a photo of what the hole looks like from the inside using a laparoscope and as you can see, with the contents removed, there is an actual hole.

  Hernias become a problem when things get stuck in them...things like intestines, fatty tissue, and other contents of the abdomen.  They can also cause discomfort due to stretching of the wall of the abdomen with straining to lift, urinate, or have a bowel movement.  Things can also become stuck, lose blood supply and die within the hernia.  Small hernias may never cause a problem.  These are the common hernias of the abdominal wall.  I won't cover the more obscure ones due to time and the others are fairly uncommon.

How do I fix them??  Today I usually fix them with laparoscopy.  This allows me to repair them with mesh that incorporates into the surrounding tissue creating a strong patch.  It also cuts down on incision size, wound infections, recovery time (minimally) and I think leads to a better repair because I can see the defect or hole better.  The mesh is placed with a great deal of overlap and tacked in place.  Meshes have small holes in them into which our bodies incorporate scar tissue making them very strong....like chain link fence on grass, the collagen holds them mesh in place making it very hard to move.  Recovery times are usually about 6-8 weeks allowing the mesh to scar in.

So, if you have a hernia, come see us at Total Body Surgical where we not only do Cosmetic surgery and Vein surgery but are professionals at General Surgery too!!

Don't forget our specials and friend us on Face Book PLEASE!!    

HAPPY NEW YEAR!!  After a two week hiatus....it is good to be back.  2012 will be an exciting year.  Lots of changes on the horizon for all of us.  Total Body Surgical will be entering its second year of service to Northeastern Oklahoma and the surrounding areas. Our success is all thanks to you.  Unless the Mayans are correct, we expect this year to be a banner one with many new changes to serve you better and MAYBE a few surprises!! 

New changes are happening this year for us.  This installment is to explain them.  Next week we will get back into the meat.

First of all, we will be adding to our team in the next few weeks.  We will be adding an ultrasound tech.  Why??  Well, as many of you know, I have been doing the pre and post treatment vein ultrasounds and quite frankly, it has become too busy for me to do them and keep up with everything else.  Our new tech will specialize in venous studies and as things in the vein center continue to grow, will take over more responsibilities with insurance and the daily running of the center.  Venous disease is way underdiagnosed and the Northeastern Oklahoma, Arkansas and Missouri are underserved when it comes to the newer techniques in varicose vein treatments.  We offer them all and as the word gets out and we continue to get great results we will need more help.

Second, we will be adding a new person at the front desk.  This is greatly needed to serve you quicker when you come in, answer phones better, and allow us to provide the service you have come to expect at Total Body Surgical.  We strive to be the best at everything we do.  We hate to make people wait and know your time is important.  I feel that the addition of our new staff will help us get closer to our goal.  Be assured that these new faces will be just as friendly and nice as Mekala, Myranda, and Janet are now.... or we won't hire them!!

Third, physical changes.  As many of you know, our corner in Grove has been undergoing massive change for the better.  The old hospital is gone, the old intersection....gone...and the new shopping center is well under construction.  The intersection, which has hindered access for several months is now finished with new curbing and asphalt.  It looks great and will serve all of us much better than the old one....thank you Grove!!  We plan to make some cosmetic improvements to the outer office, and, as you know, the interior is very nice.

Fourth, I will be making more YouTube clips.  We plan to film procedures, pre and post op instructions and more.  We will attach them to the web site so that you will have a better understanding of what goes on during your procedure and help address your questions and fears.

These are the changes we are working on for 2012.  Keep and eye out for the surprises!! 

The next few weeks I will talk a little about common General Surgical problems.  These may not be as fun as the Cosmetic and Vein discussions but are just as important, if not more so.

First we will talk about one of the more common problems...the gallbladder, then hernias, then endoscopy.  By that time we will be heading into spring.  I am working on some great pricing for "mommy makeovers" for spring that will include breast work, tummy tuck, and liposuction....very exciting.

Talk next week....Happy New Year!!