Total Body Surgical Blog

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

This is a great article that was written for a magazine in NW Arkansas.  I also wanted to mention our 2013 spring time special on Breast enhancement.  You must act now though as it is on only until April 30.  Click on the button below to see the great pricing!!

Green Country Bariatrics: There IS a Light at the End of the Tunnel!

By Nathan G. Miller, M.D., board-certified general surgeon, fellowship trained bariatric surgeon and cosmetic surgeon

“Please help me. I’ve tried every diet out there, I exercise, I can’t get rid of my weight, and it’s literally killing me.” These are the words I hear all too often from my patients. You see, obesity has become a problem in the United States, and it’s not going away – not even close.

I often see patients at their wits’ ends. They have tried everything to lose weight, and nothing works. Rest assured, there IS light at the end of the tunnel! The surgical solutions of today are unparalleled to those of the past. The complications and problems of old have been minimized, and weight loss is now maximized. And in addition to pounds lost, many patients see up to an 85% resolution rate of their diabetes issues and 50% resolution of high blood pressure problems. Several are able to get off medications altogether.

At Green Country Bariatrics, we work very closely with another fellowship-trained bariatric surgeon in the region, Dr. Josh Roller. We consult frequently about patient care and our areas of expertise. I specialize in sleeve gastrectomy and lap band, whereas Dr. Roller concentrates on gastric bypass.

What is possible?

Lap Band - A fully adjustable collar that is placed around the top of your stomach, the lap band causes you to eat less and feel fuller, faster. It is nonpermanent, and is typically done on an outpatient basis. Patients return to our clinic to tighten or loosen the band as needed, depending on weight loss and hunger. With this technique, we often see a 50 percent maximum excess weight loss, meaning, if the patient was carrying an extra 100 pounds, he or she would typically lose nearly 50. Most patients are able to return to work within a week. 

Gastric Sleeve - The gastric sleeve is an operation where 80 percent of the stomach is removed, including the hormone center for hunger. In addition, this surgery also removes the part of the stomach where food is stored, sometimes referred to as the reservoir. While this is a permanent procedure, the patient’s anatomy is not rearranged as it is in the gastric bypass or mini gastric bypass. With this technique, we often see a 70 to 80 percent excess weight loss, meaning, if the patient was carrying an 100 extra pounds, he or she would typically lose around 80. Normally, this procedure requires one to two nights in the hospital. It is less associated with malnutrition, dumping syndrome, ulcers, and internal hernias than other bariatric procedures, and it is usually performed through six tiny holes in the abdomen. Return to work is often within two weeks, and many insurance companies now cover this procedure (including Medicare).

Gastric Bypass - This is an operation that removes a significant amount of native  stomach.  Typically, it also bypasses anywhere from 90-120 cm of the native small bowel. This causes the body to absorb fewer calories and fats. It is a permanent procedure wherein the patient often loses 80% of his or her excess weight. Many times, this is a prime procedure for brittle diabetics, or those with diabetes requiring insulin for more than five years. It is also an excellent procedure for those with extensive reflux problems and a related need for weight loss.

What happens after the weight loss?  Let’s pretend we have a 10-pound sack of potatoes.  Now, let’s also imagine that we’ve taken 9 pounds out of that sack. There’s quite a bit of sack left over, right? Such is the case with weight loss. Skin has only a certain amount of elasticity. Age, yo-yo dieting and childbearing all work to degrade that elastic property. For many on a weight loss journey, removal of excess skin is often the final destination. Men and women alike often opt for tummy tucks, and also add arm lifts, neck lifts, breast lifts or thigh lifts. Essentially, these procedures are the polishing step in the complete rejuvenation of the patient. 

Tummy Tuck - A tummy tuck is performed through an incision in the lower abdomen a few centimeters above the pubic region. The incision goes from hip bone to hip bone and also around the stalk of the belly button. The skin is raised off of the underlying connective tissue and muscle up to the ribs. Next, the loose muscle and underlying connective tissue is tightened to make the abdomen flat. The skin is then pulled down and the excess is removed. A new opening for the belly button is created. The smooth, firm skin from above the belly button is pulled down, and stretch-marked tissue and scars are removed. The result? Voila: a flat abdomen.

  Typical loose skin after weight loss surgery.

Arm Lift - An arm lift, or brachioplasty, reduces excess skin and fat between the underarm and the elbow, reshapes your arm to result in smoother skin and contours, and results in a more toned and proportioned appearance.

Sagging arm skin after weight loss.

Breast Lift - A breast lift, or mastopexy, raises the nipples and firms the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour. Implants can also be placed to fill out the deflated breast.

Loss of breast volume after weight loss.

At Green Country Bariatrics and Total Body Surgical Cosmetic Surgery, our cosmetic consultations are always complimentary. If you’ve been considering these options, call us today for an appointment at 918-786-7780.  For more information, we welcome you to visit our websites and “like” us on Facebook!  Be sure to check the breast special!!!

www.greencountrybariatrics.com

www.totalbodysurgical.net

To continue our discussion about weight loss, I wanted to cover, a little better, the procedures we are offering.  As you know, not every procedure is the right choice for you.  If you come in for a consult and we don't offer the one that is appropriate, we will send you to get the right one.  The roux en y bypass, we will NOT be doing.  This procedure is a great one for those who need rapid weight loss due to urgent complications of being massively overweight.  We also will not be doing the so called mini gastric bypass as this procedure is unproven and not recognized by the Bariatric community.

The two procedures we will be offering are the gastric sleeve and the lap band.

The gastric sleeve has been around for some time now with great success and very low maintenance.

The gastric sleeve decreases the amount of food that can be consumed when eating a meal.  It also decreases the amount of the hormones produced by the stomach that causes hunger and the desire to eat.  This is a proven procedure that is done through the laparoscope with an over night stay in most cases.  The weight loss is dramatic with no adjustments. 

The lap band is for those people that can afford to lose weight in a slower fashion, and desire a procedure that does not change the anatomy in a permanent way.  The band is also done through laparoscopes and generally does not require a stay in the hospital.  Weight loss is slower with this procedure and it does require adjustments.

This photo shows the difference in the two procedures.  The gastric band and the sleeve compare well at 5 years as far as weight loss is concerned, however, the speed of the weight loss is much faster with the sleeve procedure.

As the INTEGRIS bariatric program matures, we may offer the more aggressive roux en y but for now we are not. 

We are striving to become a center of distinction in bariatric surgery and will take a little time.  Until then we will not be able to treat medicare or medicaid patients as this is their requirement.

Dr Miller and I both are also fellowship trained Cosmetic Surgeons so once your weight loss stabilizes, if you desire any of the post weight loss body contouring procedures, we can help there as well.  The most common are tummy tucks, breast lift with or without augmentation, arm reductions, thigh lifts, and butt lifts.  Facial procedures are also common with face lifts being the most common.  We are both very excited to offer these services.  It is rare to find qualified bariatric and Cosmetic surgeons, not to mention in a small town, and in the beautiful Grand lake community. 

Our plan is to start bariatric seminars within the next month in Rogers, Fayetteville, Bentonville in Arkansas and Joplin in Missouri.   We will also have seminars in Grove and in the Tulsa area.  The seminars will be informative and are required for insurance coverage of bariatric procedures.  We will also discuss cosmetic procedures briefly at the seminars to give you an idea of what is available.  You will be able to schedule appointments to start the process at the time of the seminars.

We are really looking forward to meeting many of you and hope that if you have any friends or family that are interested in weight loss procedures you will send them.  I will send a schedule, as soon as we get it figured out, by email.

Don't forget our other special pricing on laser hair removal ($50/area/treatment), breast augmentation, liposuction, and nail fungus treatment.  Press on the bubbles to see them.  Schedule today to see Dr Miller or myself...918-786-7780.

New blogs starting after the new year.

Let's hope 2012 will be a great one and that things actually do "change".

Look for some of the same offers this year AND some new ones.

Thank you all for making our year a very good start here in Grove.

Last week we discussed more common general surgery procedures that can be performed with Cosmetic procedures.  What else can be done???  It is hard to come up with a complete list there are so many. 

Here are some suggestions:

Many people have a fear of needles.  While anesthesia is administered for other elective surgery, it is a great time to place dermal fillers in the nasolabial folds, marrionette lines, or even augment the lips.  Of course Botox can be injected as well.

More substantial procedures can be done as well.  Breast augmentation can be added to elective laparoscopic procedures such as laparoscopic cholecystectomy, small laparoscopic hernia repairs, many gyn procedures and so on.  Of course if the primary procedure is being done due to infection or obstruction or other serious illness, this is not possible.

Laser skin resurfacing can be done while under general anesthesia for non-emergent procedures as well.  This allows the procedure to be done without the discomfort sometimes associated with resurfacing.  Light therapy for sun spots or closure of facial veins can also be done.

Arm reductions, small area liposuction, face work, injections, laser work, tummy tucks, breast augmentation can all be added to general surgical procedures when the procedure is purely elective. 

What are the advantages of combining procedures??  As we discussed last week, the advantages are many.  First of all, a single anesthesia is very advantageous, lowering risk by limiting the number of anesthetic exposures.  Secondly, a single surgical recovery is much better than multiple ones.  The recovery is simultaneous.

There it is, short and sweet.  Procedures can be combined if desired and safe.  Come see us at Total Body Surgical and we can discuss what is possible.  Call 918-786-7780 or fill out a contact form and we will call you!  Don't forget our special pricing on liposuction, lap bands, nail fungus, and fillers.

We are also planning Botox events in Grove and in Tulsa this month to be ready for the holidays.  Special pricing will be offered at these events.  Sign up using a contact form and we will inform you of the dates and times....or you can call.

More next week!  Oh, and like us on facebook!

What's the point???  Well, there are several.  This week I would like to summarize the past several weeks.  As obesity becomes a growing world wide problem, obesity surgery is becoming a common thing.  The common procedures are the Lap Band, the gastric sleeve, and the Roux en Y bypass.  They all have their place in the treatment of obesity.  As the procedures and massive weight loss occur, the desire and need for body contouring increase.  If you did not see the previous installments, go check them out to see what procedures are most common and in greater detail.  This installment will cover some of the high points of more detailed discussions of weeks past.

1.  Your weight should be stable for a minimum of 12 months.  Lose the weight, get where you want to be and stay there for at least 12 months before having surgery.  Doing it this way gives better results and leads to fewer repeats.

2.  You must be healthy.  Cosmetic surgery is not "minor" surgery.  People can have complications and even death from this type of surgery.  Make sure you have a healthy heart, lungs, kidneys, and that diabetes and hypertension are controlled prior to your surgery.

3.  You cannot have it all done at once.  These surgeries can be very taxing on the surgeon and you.  Sit down and figure out, in order, what bothers you the most.  Then discuss with your surgeon a strategy to attack the areas in a planned way that makes sense and is safe.  Sometimes procedures can be combined but don't get in too big of a hurry, be safe.

4.  Know what is available.  The most common procedures I see, in order, are:

-Tummy tuck

-Breast lift

-Arm reduction

-Butt lift

-Face lift

-Thigh lift

-Back lift

5.  Seek out a safe and well trained professional....nuff said.

Hope this helps.  New topic next week.  If there is anything you would like to hear about, drop me a line, jeffswetnam@yahoo.com and I will try to address it.

Thanks for tuning in and don't miss our specials.  New ones coming for the fall to so keep looking here.

I will continue to discuss procedures that are common after weight loss surgery.  The most common is the tummy tuck which was discussed in previous blogs and breasts are probably the second most common area addressed in women. 

The reason breast take such a beating after significant weight loss is that breasts are about 80% fat to begin with.  It follows that when women lose a large amount of weight, what is lost is fat and muscle.  The skin of the breast is "deflated" and what actual breast tissue remains hangs in the deflated skin....Rocks in Socks.

The objective when reconstructing the breast is to reposition the nipple and areola and if desired, refill the breast envelope.  There are options when rebuilding the breast.  One option is to lift the nipple and remove excess skin only.  This choice is certainly acceptable but does not give the fullness in the upper breast many want.  To get this, an implant must be used.  The incisions for reconstruction of this type vary based on the distance the nipple must be moved above the lower fold of the breast.  Usually the incision is an anchor type incision, around the nipple, a vertical and a horizontal incision below.  The nipple is not removed, just moved on a pedicle into its new position.  Breast skin and tissue is removed to reshape the breast.  An implant adds fullness to the upper aspect of the breast.  The implant can be placed at the same time.

Come see us at Total Body Surgical and take advantage of the specials above!!

After weight loss surgery, as we discussed the past few weeks, skin can become loose and not return to its pre-surgical state.  Last week we talked about tummy tucks, removing skin from the abdomen and tightening the underlying muscles.  This recreates the shape and tightness of the abdomen that is lost after weight loss.  Another common procedure that is requested after massive weight loss is the arm reduction or brachioplasty.  Many people gain excessive weight in their arms and after the weight is gone the skin can hang.  Many describe these at "bat wings".  The unsightly nature of this excess skin becomes hard to conceal and makes wearing short sleeves, tank tops, or anything other than a long sleeve top impossible.

What to do about it??  There are some non-invasive ways to tighten up the skin but these are usually inadequate after weight loss.  It requires skin removal, just like with the tummy tuck.  The up side to this procedure is the reclaimation of your original arm shape with the ability to wear more fashionable clothing and the loss of the "bat wings".  The down side, as with most cosmetic procedures is the scar that occurs on the medial aspect of the upper arm. Photos compliments of the ASPS.

Fortunately, this scar is on the inside of the arm and becomes less and less visible with time. 

Come see us at Total Body Surgical where we do ALL post weight loss body contouring.

ALSO, be sure to take advantage of the Lap band introduction at INTEGRIS Total Body Surgical, and the Breast Augmentation Special through the end of July!!