Total Body Surgical Blog

The past two weeks we have discussed the common and uncommon uses for Botox and similar neurotoxins in the management of facial and neck wrinkles.

The next question is "what are my options when Botox doesn't work"??

The next easy step to correcting a wrinkle that is too deep for Botox is a Dermal Filler.  Traditionally, fillers are used for diminishing nasolabial folds as pictured here....

These are lines that form from the lower edge of the nose to the lateral edge of the mouth.  They occur as fat is lost from the mid face and the skin begins to sag.  Lipoatrophy, or fat loss occurs with age and hormonal changes in us all.  This volume should be replaced, and that is what dermal fillers are used for.

The second most common area is the oral commissure or Marrionette line at the lower lateral edge of the mouth.  In this picture there are many other areas shown and fillers can be used for most of them with glabellar lines, perioral lines, and lip augmentation rounding out the most common uses.

What are fillers anyway?  Dermal fillers have been around for some time.  They have gotten progressively better with time, the biggest improvement has been the length of time they last.  Most modern fillers stay around for a year or more and some are made to stay around forever.

One of the most common fillers is Juvederm.

It is made of hyaluronic acid (a normally occurring substance in the body) that has been cross linked to make the molecule very large.  This makes it hard for the body to digest it so it stays around longer...up to 12 months.  It also has a numbing agent within the product to ease the discomfort during injection.  Juvederm and other hyaluronic acid fillers can be used almost anywhere in the face including the lip.

Another common filler is Radiesse Radiesse is made of Calcium hydroxylapatite in a sugar base that promotes collagen development when injected.  It cannot be used in certain areas of the face but is a great product for the more common areas except lips.  It is mixed with lidocaine to make injections nearly painless as well.

I think both of these products are very good and at Total Body Surgical we use them both, sometimes in combination. 

Of the permanent fillers, I like Silikon 1000.  Silikon 1000 is made to use in the eye but due to its high quality, it can be used as a filler if used carefully.  Of course it is off label and not FDA approved.  I like to use it to volumize lips and to treat some acne scars.  It works great when done properly and is permanent.  This can be very economical over time.

Next week I will talk about the more unconventional uses for fillers....some you may not have thought of.

Come see us today at Total Body Surgical and take advantage of our special offers.  Call 918-786-7780 where Cosmetic Consultations are complimentary!

NOW UNTIL THANKSGIVING....BUY ONE FILLER (Juvederm or Radiesse)AND GET THE SECOND ONE AT HALF PRICE!!!!!

Last week we discussed (and hopefully dispelled) many of the myths about the use of Botox.  The FDA  has approved the cosmetic use of Botox in the  Glabellar region or the area between the eyes and forehead.

However, off label uses for the medicine have become common place.  I like to use it around the eyes to elevate the brow, treat crows feet, and to open the eye to show more of the iris or colored part of the eye.  Botox is VERY effective in these areas and due to the small size of the muscles, it requires only a very small amount.

  Notice the "crows feet" around the outer aspect of the eye and the hypertrophy or enlargement of the muscle below the eye.  Botox works extremely well to smooth these areas creating a more youthful look.

Another area that can be improved is the neck.  Many men and women develop banding of the muscles that lead to wrinkling of the skin.  Botox relaxes the muscles that cause the banding and the skin smooths very well.

A third area is around the mouth.

Many people start to form lines around the mouth due to the pursing motion of the muscles around the lips and loss of volume.  Smoking, using a straw, pursing the lips all create the lines.  When used carefully, Botox can help smooth these areas.  Add some volume and the mouth appears much younger.  Be warned that it may create some temporary weakness and this should be expected.  The chin area can also be smoothed with botox.

Another off label use is for Masseter muscle enlargement.

This can occur due to genetics or teeth clenching.  Botox can weaken the muscle and allow it to shrink giving the face a less angular look.

Botox can also be used to treat hyperhydrosis or excessive sweating.  The best area to treat is the under arm but it is also effective on the palms and feet.  Many people have this problem that cannot be resolved with anti-perspirants.  A simple test done at the time of treatment shows where the sweating is most profuse and small amounts of botox are injected.  It is very effective and seems to have good longevity....6 months to a year.

These are just a few of the off label uses for Botox.  There are many others and more are tried all of the time. 

Next week I will discuss volume replacement with dermal fillers and other things such as fat or implants.

Be sure to check our liposuction, nail fungus, and lap band offers.  Many are taking advantage of them, saving significant money, and getting GREAT results!!

Cosmetic consultations are complimentary so call today 918-786-7780 or fill out our contact form!

Watch this video for a little laugh....

http://youtu.be/nB7wtLMsm5c

This little cartoon displays many of the myths about botulinum toxin and its use in making us look younger.  Botox, made by Allergan, and Dysport, made by Medicis, have been around a long time.  Other similar products are on the horizon and these newer products will be just as effective and may drive down the cost.

For this blog I will refer to all of them as Botox as it is the most notable. 

Botox was originally marketed for muscle disorders that caused spasm, disfigurement, and pain.  It worked very safely and very well.  As time went on, many of us realized that wrinkles in the face were caused by common muscles of expression that, over time, cause the skin that overlay the muscles to crease.  The areas most commonly noticed are in the forehead, between the eyes, and the crows feet around the eyes.  They are caused by us raising our brow as if surprised: forehead wrinkles, looking concerned: the "elevens" between the eyes, and smiling or squinting in the sun: crows feet.  It was noticed that when these muscles are weakened with Botox, the wrinkles were markedly reduced.  Over time, FDA approval was requested and granted for Botox use in these areas for cosmetic reasons. 

Treatment with Botox started off being only for the "wealthy" as the cost was high.  Also, there were many misconceptions about the complications that could occur and fear due to rumors of deaths from the proper use of the product. 

Here are the facts:

1.  Botox and other similar products are very safe.  The amount injected by qualified injectors is so small that there is essentially no risk of any serious complication.  As with any other injection, there is the small risk of bruising and if the medication is injected into the wrong muscle group there could be some brow droop or eyelid droop that is self limiting.

2.  Botox is not an anesthetic.  It does not cause numbness where injected.  It does weaken the muscles but when done correctly, they can still be moved, just not with as much force.

3.  Botox does not work immediately.  In some of the smaller muscle groups it works quickly (within a few hours), in the larger muscle groups it may take as long as a week.

4.  Botox is not permanent.  In the typical patient, it lasts about 4 months.  Some shorter and some longer.  The average patient receives Botox every 4 to 6 months.

5.  Some wrinkles may not disappear with Botox.  Deep wrinkles that have been present for some time will be softened after injections but probably will not go away. 

6.  Botox does not "fill in" wrinkles.  It simply slows down the underlying muscle strength and if the skin is able, it will smooth out by not being wrinkled by muscle contraction.

7.  Botox is now becoming very affordable.  Prices, due to increasing competition, have fallen.  Also, as new products come to market, the price of the product should fall, allowing us to charge less.  The average price of a treatment now is around $250-$300 where it used to be twice that much.

8.  Treatment with Botox usually takes less than 10 minutes.  I use the smallest needle I can get and it is essentially painless.

So, there you have it!  Hopefully these points will help dispense many of the myths that surround Botox use.  It is one of the most effective medications I have ever used and patient satisfaction exceeds any other medication when used on the right people. Like Total body Surgical on Facebook and get Botox at $9.00 per unit!!! Don't forget our liposuction special pricing and the newest treatment for toenail fungus!!

Call or fill out our form for a complimentary cosmetic consultation....918-786-7780!!!

I am writing on liposuction today to introduce a fall pricing reduction at Total Body Surgical!  We are pros at this procedure and NOW is the best time to do it.  Why??? Well, liposuction does take some time to completely heal and "stabilize".  Getting ready for next summer starts today!  I have extensive training and experience with all types of liposuction and not to toot my own horn....am pretty good at it!

Liposuction has been around for a long time.  The first procedures were deadly in fact.  It was rediscovered and refined later but still often required blood transfusion and hospitalization.  Due to the work of Dr. Klein (a dermatologist), new and better transformations in the procedure now make it safe and more effective for the right people. 

Who are the right people you might ask.  Liposuction works best for those who are "in shape" but have problem areas.  A chubby tummy, hips or love handles, saddle bags or outer thighs, inner thighs, chest, arms, or neck.  Liposuction IS NOT a weight loss procedure.  For those with smaller areas that they just cannot get rid of, liposuction is a procedure you should consider.

Modern liposuction can usually be done in an office procedure room.  We use sedation and tumescent fluid so that you can come and go the same day.  Tumescent fluid is the key to limiting pain and blood loss.   The technique, developed by Dr. Klein, is based on good science and is very safe when done properly.  The fluid is made using lidocaine (a local anesthetic), epinephrine (a normal chemical in the body that causes blood vessels to constrict or get smaller), and saline (salt water in concentrations that occur in the blood).  After marking the areas to be treated and sedation, the areas are injected with this fluid.  This causes the blood vessels in the area to constrict and numbs the area thus markedly limiting blood loss.  The areas fat is then removed with a small hollow tube.  This is done very carefully to not leave any defects or dents.The channels of fat removed shrink with time and the area smooths and recontours.  Without the fat!  Vaser and Laser liposuction are technologies that are used to heat the skin so that it shrinks to fit the smaller size of the underlying fat pad.  In my experience, using these technologies alone, without revoming the fat, does not give satisfying results and recovery times are about the same....a few days, then soreness for a couple of weeks.  The fat that is injured during the procedure and not removed is absorbed by the body.

The complications that can occur are:

-lumpiness (usually occurs if weight is gained after liposuction)

-bruising (resolves with time)

-sagging skin (the one variable that cannot be controlled.  Usually not a problem if the areas are selected appropriately)

-hyperpigmentation (especially in ethnic skin)

-dents (occur by removing too much fat in an area and can usually be repaired with revision)

Deaths can occur and are discussed by the media at length.  These usually occur when inexperienced physicians give too much lidocaine.  We are very meticulous about the dosing and when done properly, lidocaine toxicity is very rare.  However, any cosmetic procedure can have REAL complications and should not be taken lightly!  That's why I only do liposuction in the office on healthy individuals. I see patients personally, evaluate them, discuss the procedure's risks and benefits, and if I feel it is not the procedure to give you the results YOU desire, I will tell you.

Please go to my portfolio page to see some of my results and click on the picture or button to see our exclusive pricing on liposuction.  ACT NOW as this is a limited offer!!  Call 918-786-7780 for a complimentary consultation or fill out the contact form and we will call you....I look forward to meeting you!!

Do I need a lift?? Todays blog is in response to a question I was asked on Facebook.  This is a question I hear almost daily.  It's a question many women are scared to ask.  The four most common cosmetic breast procedures are:

1.  Augmentation.

2.  Breast reduction.

3.  Breast lift.

4.  Breast lift with Augmentation.

So how do you decide what you need??  First, reduction.  Breast reductions are done cosmetically for women who have breasts that are too large for their frame.  They are so big that they interfere with life in general.  Clothing doesn't fit, bras are difficult to find, they can be embarassing.  They become a medical issue when neck pain, back pain, rashes, strap marks, etc. start to occur.  This is when insurances start to kick in and may cover the procedure.  They usually require certain criteria to be met and a certain volume must be removed for them to pay.  A reduction is done to reduce volume and make the breast smaller.  A lift is done to reposition the nipple.

Lift vs. augmentation vs. lift and augmentation.

The choice of procedure is at times a judgement call and also depends on what the patient is looking for.  It all depends on the position of the nipple relative to the infra-mammary fold. (the fold below the breast where the breast stops and the chest wall begins)  If the nipple is well below this fold then a lift will usually be necessary.  If this breast is augmented, the nipple will still hang and the "Snoopy Nose" breast occurs, nice implant with a drooping breast over it.  The nipple must be raised and centered either in the breast or placed where it will be in the center of the implant.  If the nipple is above the infra-mammary fold then usually only an augmentation is done.  When the nipple is at the fold is when good judgement and figuring out what the patient is after, managing expectations, and all the other unmeasureables come into play.  For a lift, you will have scars.  They usually heal very well and after a little time are fairly inconspicuous, but they are there.(nipple above the fold-augmentation)

If a lift alone is done, the upper pole of the breast has a slope to it and may lack fullness.  Many women don't like that look and for them, an implant gives the breast a fullness that recreates the youthfull breast.

Notice the lateral view where the upper pole is sloped after a lift/reduction only.

Notice the fullness in the upper pole after a lift and augmentation.

I hope this helps clear some things up about what procedure is right for you if one is desired.  If you have a question, facebook me and I will address it.  Next week I will discuss liposuction.  Don't forget to check out our specials!!

Onchomycosis, also known as nail fungus, is a very common problem.

It is a problem that can make people very self conscious and is often very difficult to treat effectively. The cause is a fungus called tinea unguum.  The fungus infects the nail bed where it is protected, moist, warm, and has a good supply of food.  Common risk factors for fungal infection are:

• Getting manicures and pedicures using utensils that have been used on other people

• Getting minor skin or nail injuries

• Having a nail deformity or nail disease

• Having moist skin for a long time

• Poorly functioning immune system (Diabetes and smoking)

• Wearing closed-in footwear

Symptoms

Nail changes on one or more nails (usually toenails):

• Brittleness

• Change in nail shape

• Crumbling of the outside edges of the nail

• Debris trapped under the nail

• Loosening or lifting up of the nail

• Loss of luster and shine

• Thickening of the nail

• White or yellow streaks on the side of the nailThese changes in the nail are unsightly and can lead to discomfort, and to the inability to wear certain footwear due to the thickness of the nail.  Until recently, the problem was very difficult to treat.  Creams, vinegar, nail removal, were the only options.  Then came oral medications:

Over-the-counter creams and ointments generally do not help treat this condition.

Prescription antifungal medicines taken by mouth may help clear the fungus.

• You will need to take the medicine for about 2 to 3 months for toenails; a shorter time for fingernails

• Fluconazole griseofulvin, terbinafine, and itraconazole are used to treat this condition.

• Your health care provider will do lab tests to check for liver damage while you are taking these medicines.

In some cases, the health care provider was required to remove the nail. Nails grow slowly. Even if treatment is successful, a new, clearer nail may take up to a year to grow in. AND the treatment effectiveness is only about 50%.

So why am I writing this???  Well, there is a new treatment that is being used that is about 80% effective and I can give it to you.  NO blood tests, NO risk of liver damage, NO anesthesia, NO pain.  Also, very quick and usually only takes two treatments.  It is done using FDA approved laser treatment. 

The treatment is done in the office and takes about 15 minutes.  We use a 1064 YAG laser that warms the nail and kills the fungus.  We treat all 10 toes and repeat the treatment in 6 weeks.  Usually the nail re-grows and looks normal in 3-6 months.  NO anesthesia is required and can be done on the day of your first visit is you schedule.  If more than 2 treatments are required, the cost is greatly reduced.

The expense of the medications and lab work required could exceed $1000.00 and, again, was only 50% effective.  The laser treatment for all toes, both feet, two treatments is $800.00...very affordable.

Book your appointment today and tell them it is for treatment of nail fungus so we can schedule laser time.  We will have you back in open toed shoes or sandles before next summer!!!  Call 918-786-7780 or fill out the contact form and we will call you!

Don't forget out lap band special AND we are starting a new liposuction promotion until Christmas...get one area 10% off and get a second smaller area FREE!!!                          

Click on image to see lipo special offer!

For the last installment on veins in this series let's discuss the pesky spider vein.  These veins are very common and can be unsightly.  I probably hear more complaints about spider veins than any other vein problems.  They can occur in young women, old women, and every age in between.  The cause of these veins which occur superficially in the skin is usually hereditary and they are aggravated by standing for long periods.  They can occur alone or may be associated with a bigger underlying vein issue.  The reason they enlarge and become visible is increased venous pressure.  Good news is, when these veins occur, they can be treated. At Total Body Surgical, we have a number of methods for treatment.  First, if the problem is extensive, we go out of our way to ensure that the cause is not just a symptom of an underlying bigger vein problem.  At the Total Body Surgical Vein Center we use ultrasound to make sure the larger veins are healthy.  If the spider veins are limited, or if the larger venous system is healthy, we then focus on the cosmetic treatment of the spider veins themselves.  Dr Swetnam usually uses sclerotherapy to eliminate them.  This is a minor procedure that is performed in the office.  It is fairly quick and with minimal discomfort.  A solution is injected into the spider vein that causes inflammation of the lining of the vein, eventually causing your body to remove it so that it can no longer function, or be seen.   This may take a few treatments and requires the wearing of compression stockings for about 2 weeks after injection and avoidance of strenuous exercise and hot tubs for that time as well.  In some instances, some brownish discoloration can occur around the site that usually resolves.  Some ulceration of the skin can also occur which heals well but can cause some minor scarring.  If the larger veins are diseased and the spider veins are injected, they will recur.  If we do a diagnostic ultrasound that shows the larger veins are not functioning, we treat those first with laser closure.  This stops the pressure and then allows us to treat the smaller veins with sclerotherapy successfully.I also use the Vein Light to isolate the "reticular" or connecting veins that feed the spider vein.  This allows me to see what is feeding the group of spider veins and inject it as well. 

For much smaller areas I sometimes will use the YAG laser to close them.  This is relatively quick.  I also use the laser when treating facial veins.  These commonly occur around the base of the nose, on the cheeks and chin.  They are very common in people with rosacea. 

Treatment of spider veins is an ongoing process and should be maintained.  Most people with significant spider veins will eventually meet criteria for treatment of the larger veins that are the root of the problem.  Patients with facial veins will also need maintenance.

Next week....fungus amungus.....the newest treatment for toe nail fungus!!!

Keep an eye out for new specials for fall!!!!

Come see us at Total Body Surgical for Obagi products, Skinceuticals, Botox, Juvederm, and all laser services.  Coming soon....laser tattoo removal!!

918-786-7780

Sorry everyone!! An Internet crash at the Grove address forced me to delay writing this installment.  The double edged sword of modern technology. 

This week I want to discuss removing the large varicose veins.  This was once done with larger incisions that left unsightly scarring.  We now perform what is called the European Micro phlebectomy.  What that means is that the veins are removed using a technique developed in Europe.  The difference is that this technique leaves very little scarring and is much more Cosmetically appealing than the old way.

The large varicosities that we see in the leg is usually not the actual disease.  As discussed in previous blogs, this disease is from incompetent valves in the saphenous system in most cases.  These big and ropey veins develope in response to the increased pressure in veins deeper in the leg.  Once closed with the laser, the deeper veins no longer feed these enlarged "branches" or varicosities.  When this happens a number of problems can occur, they can become painful, they can clot and cause phlebitis, they can cause skin color changes.  These problems will usually resolve with time but can be miserable. 

How is the procedure done??  After closing the system that is feeding the visible varicose vein, the large ropey veins are marked with a marker with the patient standing.  Local anesthesia is injected into the areas to be removed and in our office, IV sedation is given.  Once the local has taken effect, very small incisions are made and small instruments are used to grab the vein, elevate it, and tease it out from under the skin.  It is completely removed if possible.  The incisions are no more than a couple of millimeters in size (less than an eighth of an inch).  No stitches are placed, and a compression dressing is applied with Coban to hold pressure.  Some minor bruising may occur that lasts for a few days, the wounds may leak minimally for about 24 hr or so.  We have patients walk out of the office and most experience very little discomfort after.  The wounds heal very well and usually go unnoticed after 6 months or so.  Once removed, the painful and ugly source of embarassment is gone.

Next week....Cosmetic sclerotherapy and how to get rid of spider veins.

Call Total Body Surgical today for YOUR vein evaluation 918-786-7780!

Last week the discussion was all about the causes of venous problems that occur in over half the population.  This week the discussion will be about treating the problem and some of the common hurdles faced when attempting to encourage payment from our wonderful insurance carriers.  The good thing is that if criteria are met, insurance will usually pay for treatment.  What are the criteria??  Well, they are somewhat variable.  First, there must be symptoms.  Pain, swelling, skin discoloration, aching, restless legs, and at the worst, ulceration and chronic changes.  Second, there must be ultrasound documentation of the problem.  This includes dilation of the veins or vein, and reflux of blood which demonstrates the absence of proper valve function.  Third, many require failure of conservative therapy with compression stockings for varied lengths of time....in some cases for up to six months.  Of course, treatment of spider veins is NOT covered as it is considered cosmetic.  A great deal of the time, however, these pesky spider veins are caused by an underlying bigger problem with the larger veins and this is covered.  The reason that's good is that after treating the larger veins, getting rid of the spider veins usually is much more permanent and they don't come back!!

The way it works at Total Body Surgical, we see you for a consultation and examine the problem.  If it is obviously a venous issue, I will give you stockings to start your time requirement, if present, and schedule an ultrasound.  At the ultrasound, we will discover what the extent of the problem is and how many veins are involved.  At that point we will figure out the treatment plan.  The important part of the ultrasound is measuring how much and where the reflux is located and document this.  Once all of your insurance criteria are met, your procedure, or procedures are scheduled.  At the procedure we use sedation for your comfort.  We use the cooltouch laser and tumescent local.  The laser fiber is inserted into the vein, the tumescent local is injected around the vein and the fiber is activated and pulled back the length of the vein to heat seal it.  This redirects the flow of venous blood to the deeper system where it is supposed to go anyway.  Sometimes, depending on how many veins are diseased, this may require more than one treatment.

Pictured above is the laser fiber itself and a rendition of what happens inside the vein when it is inserted, activated and retrieved.

Next week we will talk about removing the large varicosities that branch off of the veins that are closed by the laser.  This is known as European microphlebectomy.

We are approaching the final week of the breast augmentation special and don't forget our lap band introductory offer.

New special for fall to be announced next week!!!

Thank you for visiting!

Since there have been no requests about special interests, I get to choose!!  The next few weeks I will address veins and what to do about them.

The reason Cosmetic Surgery and Vein Surgery are so intimately associated is quite simple.  I can liposuction, augment, and tuck everything to make the body look great, and yet, if your legs look like this.....

it makes it hard to wear a dress, shorts, a swimming suit, or any other attire. 

Vein disease or chronic venous insufficiency, is a common problem.  It is thought to effect at least half of the population to varying degrees.  It is thought that the problem is hereditary, but can have other causes such as trauma or thrombosis (clotting).  The veins causing the problem have valves in them that no longer work properly.  The muscles of the lower leg act as a pump to move blood up the veins as they contract.  The valves are supposed to allow the blood to travel towards the heart but not let it return down the leg.This picture illustrates normal valve activity.The second image shows a comparison of normal with abnormal function.  When these valves are defective, the blood is allowed to return down the leg, increasing pressure and causing tributaries to dilate and become tortuous.  Spider veins also develope as the pressure causes enlargement of smaller veins in the skin.  The disease is not limited to appearance either.  This process causes cramping, restless leg syndrome, skin discoloration, rashes, ulceration with secondary infection, swelling, and ultimately, disability. 

The reason that these problems happen is multifactorial.  Pressure, low oxygen tension in venous blood, and the leaching of iron products from the hemoglobin in the blood and into the skin.  Depending on the severity of the reflux these symptoms may occur early or late in life.  

I hope this discussion helps shed light on why venous problems develope.  Over the next few weeks we will dive into the diagnosis and treatment of chronic venous disease.