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!!

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

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

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

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

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

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

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

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

Don't miss the last days of the spring breast augmentation special at TBS...$3500 until April 30!! What this means is that you must consult with one of us, get an official quote, and then book your procedure by the 30, not have the surgery.  We will honor the quote for 60 days, so it's NOT TOO LATE!! Hit the button below for details...

This weeks article, by Dr Miller covers a great deal about how we do liposuction.  We are kicking off another springtime, body improvement, get in shape for summer deal, this time with great pricing on liposuction...the smart way.   

LIPOSUCTION: FACTS AND MYTHS

GENETICS

Liposuction, like all cosmetic procedures, is a combination of skill and artistry.  It sounds hokey, but just as each person is taught they are a snowflake in grade school, every individual requires a very personalized approach when addressing areas of fat.  Now, typically speaking, many women usually tend to focus their problem areas as being the lower abdomen, flanks (the dreaded muffin top), and arms.  Meanwhile, guys tend to focus on their chest and belly.  Obviously, crossover does occur regarding areas; and to be perfectly honest, it all depends on how we pick our parents! 

AM I A CANDIDATE?

Many people will begin to notice collections of fat, post baby, (men included) that they just can’t get rid of.  Others will turn to liposuction when they have pesky areas that just won’t disappear,  no matter how much exercise and dieting they do.  Still others want extra help in appearance for a wedding or class reunion coming up.  Whatever the case, liposuction is a spectacular avenue to help someone on the  road to the body that they envision.

JUST A TOOL

It should be emphasized that liposuction is only a tool.  Specifically, it is NOT a weightloss technique.  Without a doubt, one will lose weight from the procedure, but its main focus is actually to shape by removal of fat. In addition, once a person has  liposuction, that area where fat is removed means that it is gone for good.  However, this doesn’t mean you’re free to go and gain weight- quite the contrary!  In fact, weight gain will go to other areas of your body, making it look abnormal.  We encourage our liposuction patients to utilize this opportunity as a complete jumpstart to a new and healthy lifestyle. From a very positive point of view, if fat is removed by liposuction from problematic areas, this also means that calories burned by diet and exercise in the future will then be focused on other areas, rather than those where fat has been removed. 

WHAT IS THE PROCESS?

STEP 1

Essentially, the way liposuction is done at Total Body Surgical is a 3 step process.  Though it is not commonly practiced outside of the East and West Coasts, our liposuction is usually performed with what is called the  tumescent technique.  It has also been termed, “lunchtime lipo”, “Smartlipo”, or “laser lipo”.  Patients remain awake throughout the procedure, receiving local anesthesia in the areas of treatment. This allows the patient to communicate with the physician throughout the procedure. It also helps physicians provide great results by allowing them to easily position the patient in the best way possible to treat each area. For those that may be concerned about being awake during the procedure, patients are provided medications to assist in their relaxation and comfort.

In addition, the tumescent technique allows the patient to avoid the general anesthetic that is so hard on your health.  Many times, the recovery from a surgery is not so much related to the procedure, but rather to the administration of the general anesthetic.  Essentially, tumescent technique cuts your recovery time by at least 50%.  Meaning, it is a quicker return to work and your daily activities (typically 3-7 days). 

STEP 2

After getting the patient numb, the second step of the process begins.  Many people have heard the term, “Smartlipo”, or “laser lipo”, which is essentially the utilization of a laser to melt the fat in the  problematic areas being addressed.  Utilization of the laser also decreases swelling, bruising, and also helps to speed recovery.  This is especially true when compared to the old way that liposuction has traditionally been performed. The micro-laser is so tiny that it can contour small areas that were more difficult to treat in the past, such as upper arms and under the chin. This technique smoothes out the work done with the power-assisted micro cannulas and stimulates collagen formation which can help the skin tighten, producing a smooth final appearance to the treated areas.

STEP 3

After the fat is melted, then the fun part begins.  Meaning, all of the melted fat is then gently  removed  by a very small suction tube.  This is where inches are lost, and new waistlines are formed.  The majority of the time during the procedure is spent on this stage.

Am I A Candidate?

Most importantly, you must be in good health. Ideally, not having any active diseases or significant pre-existing medical conditions is best. 

Make sure you  have realistic expectations of the outcome of liposuction. Open communication is absolutely imperative! You have to clearly understand what your desired results are and be able to convey  this information to your surgeon.  Then, discussion of your goals with your surgeon to determine what can feasibly be done to reach all or part of this goal will be essential.

Further, the elasticity of your skin plays a huge role in whether you are a good candidate. You should have good elasticity, so that your skin is able to shrink  back to its former tightness once the fat is removed. As we get older, have babies, and yo-yo diet, our skin loses its elastic property.  Think of it this way:  if you took a brand new pair of underwear out of the package and stretched out the elastic waistband for 2 hours, then let it go, it wouldn’t snap back to the way it was when you took it out of the package brand new, would it?  Our skin is much the same.  In addition regarding your skin, if you had a 10 pound sack of potatoes and you took out 8 pounds, you’d have quite a lot of sack left over, right?  Obviously, we want that sack to shrink up. Analogously, when you take a large amount of fat out of an area, you’ll have the tendency to have extra skin.  This is where using the laser comes into play. Utilizing the laser (remember stage 2 of the procedure) optimizes the chances that this will happen.  However, the overwhelming factor of whether or not this skin will shrink back  is by far and away your genetics.  How we picked our parents plays a huge roll in this life!  The presence of stretch marks is a flashing neon sign that your skin is not what it used to be, and may not shrink up as tight as it would have when you were 18.  However, many patients really just desire to look better in clothes.  Having extra skin after removal of fat will not effect this.  Again, discussion of realistic expectations between you and your surgeon is a must!

Hit this button to see the great offer we have going until May 30!!

That is the question we hear daily.  Do I NEED a breast lift??  With this being one of the last installments on breast for a while, I thought a little knowledge in this area would be helpful. 

Before we start, let me remind you that we have 20 days left on the spring time breast augmentation special pricing....click below to see how you can get breast augmentation surgery, ALL INCLUSIVE, for as little as $3500.00!!

Now for the burning question...do I need a breast lift??  The answer to that question is, in some cases, a little fuzzy.  There are instances where the decision is easy.  If you have no breast tissue, or very little, and the nipple position is high, obviously, you do not need anything to enhance the breast except volume, i.e. implants. 

 In this picture, the nipple position is great, the skin is tight, and only an implant is necessary.  After implant placement, the skin will stretch to accomidate the implant and the breast will take on a nice and natural shape.  This is the perfect patient for implants alone.  As discussed in earlier blogs, the incision placement options, size, and type of implants are variable according to taste. At your consult, all of this will be discussed and you can decide.

The second presentation that is fairly easy is the patient that has significant drop in the nipple position

If the nipple has fallen below the fold under the breast (inframammary fold) then a lift is always needed.  Some select an implant and some do not.  That is a personal choice, but if fullness is desired in the upper chest, it is difficult to create, and maintain, without an implant.

This picture depicts one of the "easy" decisions.  Obvious drooping of the breast and nipple complex below the lower fold of the breast where it attaches to the chest.  If we were to just place an implant in this situation, there would be a nice implant present with a sagging breast hanging off with the nipple still pointing at the floor.  Several procedures are used to lift the breast.  We usually use the Weiss pattern lift (anchor incision) for larger lifts and the vertical (lolly pop) lift.  Both types of lift raise the nipple into a more normal position, remove excess skin below the breast and move remaining breast tissue into a higher position.  In the picture above, we call this the "rocks in socks" breast.  There is some breast tissue hanging around the nipple (rocks), and skin (socks).  If lifted only, this will be a very small and flat breast.  This is when an implant can really be beneficial to give the breast some volume.  Others have a sagging nipple and breast but still have a good amount of volume.  A lift alone, or with implants are both choices.

This is a photo of a breast lift alone. The shape is nice and nipple position is good, however, the upper pole remains flat.  This can only be fixed, long term, with an implant.  Implants, however, can be placed after a lift so you can decide later if you want them or not.

As you can see, a lift with an augmentation can be done simultaneously with good results.  This gives good fullness to the upper pole of the breast with the added benefit of only one procedure.

Now for the harder ones.  Many women have breasts that have fallen some but not to the extent we have discussed.  When the nipple is just above the lower breast fold or even with it...now what??  When the nipple is above the fold but there is significant breast tissue below, this is called pseudo-ptosis or false droop.  We have more than one option at this point.  One is to put large implants above the muscle, preferably silicone.  This is actually not a bad option for the right person.  The breast will still remain a little low, not filling the upper pole as much as if a lift were also done. Also, need for a lift later is still a real possibility. This is good for those who do not want scars on the breast and are willing to accept a breast that is not quite as "perky".  The other option for this group is to go ahead and bite the bullet and do the lift with or without implants.  This will generally fix the problem long term, give you a nice fullness to the upper breast and move the nipple into a more normal position.

Breast pseudoptosis with implants.  Looks pretty good, but upper pole is somewhat flat.  If this is acceptable, it is a great choice.

Well that about does it for this week.  I will try to move on to something else next time.  Remember our breast special pricing and call today....918-786-7780 or 1-866-weight0.  Cosmetic consults are complimentary!!

Hard to tell by the weather, but Spring IS here, not only by dates, but soon the warmer weather too.  In keeping with our Spring $3500 breast augmentation offer, we will discuss breasts.  There are a little over 3 weeks left to take advantage, so click on the button below to get details and fill out the contact form.  We'll get back with you.  Or call 918-786-7780 or 1-866-weight0 to schedule an appointment that will be complimentary.

I think we have about beat this subject to death but wanted to go into a little more detail about approaches to implant placement and some of our thoughts.  This will help YOU decide.  You deciding seems to be a recurring theme here, but you need to happy with your choice of implants and how they are placed.  Understand that we are happy if you are happy!!  The size you choose, the insertion approach you choose is all about you, not us.  We are here to help guide you in making your decisions.  Dr Miller and I have a great deal of experience with these choices and can help guide you.  Trish, Janet, Rachel, and Wendy also have experience, some have had this type of surgery and they are here to help too.  They are also WOMEN, this gives them a leg up, as politically incorrect as that statement is!!

A couple of things that have been glossed over you need to know about....

1.  Sizing:  When it comes to the size of implant you want or need, there are several factors involved.  Your height and weight.  Your build, thin, athletic, or larger build, your current breast size, and your desired size after augmentation.  We always hear comments on implant size based on what the internet says or friends comments, or the size someone else received.  You can usually throw all of these comments and suggestions out of the window.  Why??  You are unique.  The amount of breast tissue you are starting out with is not exactly the same as everyone else.  The size of your chest is not the same as everyone else.  You are taller or shorter, thinner or fluffier than everyone else.....one size DOES NOT fit all in this situation.  We start off by talking to you to get an idea what you want.  We then measure your current breast location, how big the current breast is, and the size of your chest. This helps us to figure out a range of implants that will be right for you.  If you have 100cc of natural breast tissue and want to increase to a 400cc breast, we need to look at implants around 300cc.  If your friend started out with 300cc of natural tissue and ended up with a 200cc implant, she may think your 300 is "large" when if you consider where you both started....it is about the same...right?.....right.  We will allow you to try different sizes on, in your clothes, so you can get an idea what you will look like.  We will also help you choose the style of implant you want.

There is a new higher profile not pictured here.

2.  Placement approach:  How do you want the implant placed??  Also an important question.  The options for saline are, armpit (transaxillary), below the breast (inframammary), through the nipple (peri-areolar), or through the belly button (TUBA).

 Arm pit incision-saline or silicone.

The incision is only 2-4cm, not this big!! Saline or silicone.

incision around the nipple. Saline or silicone.

Silicone cannot be placed through the belly button.

We all have our preferences but we are here to help you decide what YOUR preference is.  Here are the ones I don't like.  Peri-areolar approach is less ideal because it can cause sensation changes around the nipple and leaves a scar on the breast.  I also am not too fond of the TUBA.  It has a higher incidence of assymetry and can also cause unsightly scarring around the belly button.  My first choice is trans-axillary (through the arm pit), Dr Miller's is under the breast.  There are several reasons why I like the arm pit...one is that there is no scar on the breast.  I choose a small crease in the arm pit that is there in everyone and use it to make my incision.  This usually heals well within 6-12 months and you can barely find it....no scars on the breast and the scar that is there is concealed.  My second choice is the infra-mammary incision.  This incision is probably the easiest one to use as it is the least remote from where the implants are placed.  It is also a commonly used incision later if implants are replaced or any other work on the capsule is necessary.  The down side....an incision on the breast, even though they usually heal very well.

So don't forget to call 918-786-7780 or 1-866-weight0 to make your appointment.  With only a little over 3 weeks left, the time is now.  As long as you book before April 31, you can pick any date after and still get the special pricing.  Call TODAY!!

HAPPY EASTER FROM TOTAL BODY SURGICAL AND GREEN COUNTRY BARIATRICS

With our breast implant spring deals going on, we felt like we better talk about breast implants and enhancement.  What spring deal, you might ask??  Click on the button below to get all the details....

When you come to Total Body Surgical for a breast consult, the first thing that will happen is a discussion about implants.  We cover about every positive AND negative to having implants and contrast and compare the saline with the silicone gel implants that are currently available.  We feel it is very important for you to have all of the knowledge. 

First is saline.  Saline implants were made popular when the silicone implant scare started in the 90's.  These implants are a bag that is placed empty and filled with saline.  They can be placed through an incision under the breast, through the arm pit, through an incision around the nipple, or through the belly button. If a lift is required, then we use the same incisions.  We usually discourage using the nipple access for obvious reasons.  When placed throught the belly button, the incidence of assymetry is reportedly higher.  We generally use the arm pit or an incision under the breast.

The pros to the saline implant are several.  One thing that we can do with them is over fill them.  This makes them look like implants.  Some women want this.  Another advantage is if they rupture.  If this happens, the saline is absorbed and the implant goes flat.  We simply replace the implant and you go on your way.  Because saline implants are put in flat, they can be placed through a smaller incision whichever approach you decide upon.  Most studies support a lower capsular contracture rate with saline implants (this is when the implant is distorted by a thicker and tighter capsule that makes the implant feel hard and can cause distortion).

 Capsular contracture on right with implant thightening and displacement.  It would feel very hard if you could feel it.

Lastly, and in many cases most importantly, saline implants are cheaper.  They are about $1200 cheaper than silicone implants.

Now the cons.  Some people think that saline implants don't feel as "natural" as silicone implants.  Secondly, saline implants are generally placed under the muscle to avoid some of the limitations of the implant.  Thirdly, saline implants have a higher incidence of "rippling".  Ripples are creases that can form in the implant.  They are more prevalent in women who are very thin and get larger implants.  This can occur with silicone implants as well but less so.

  implant "rippling"

Now for pro's of silicone gel implants.  Some women think they feel more "natural" than saline.  Some women think they have a more "natural" shape.  I think, in the moderate profile shape, they both can look great.  In the high profile shapes, it is my opinion that the silicone gel is the implant of choice and looks better.  It is also my opinion that when implants are placed above the muscle, silicone is the implant of choice due to its lower pressure.  It ripples less and looks better.  Below is a video of what a silicone gel implant looks like when you cut it open.

http://youtu.be/kceaEMmi7pA

The con's.  You must be 22 (the infamous FDA) to get them.  Silicone gel implants are full when we put them in, therefore, the incision must be slightly larger than with saline.  Studies show that the capsular contracture rate is slightly higher than with saline.  Silicone gel implants are more expensive than saline. Implants made of silicone cannot be placed through the belly button. 

So there you have it!  We feel that implant selection, size and content, is a personal choice and should be made by you.  If you are unsure, we will help guide you in the selection process.  Our office staff is also very good at sharing their experiences with you and giving the "woman's touch" helping you decide.  Dr Miller and I share most of our opinions with only slight variations.

Call us at 1-877-weight0 or 1-918-786-7780 today to schedule your complimentary Cosmetic consultation.  Remember, to take advantage of the 2013 Spring Special Pricing, you must book your surgery by April 30 so don't put it off!!

We look forward to seeing you!!

It's VERY close to spring (thank God) and summer is right around the corner.  I wanted to blog today about something very special.  If you have ever considered breast enhancement surgery, you MUST pay attention.  Dr Miller and I have a special offer for you and it is limited, so you will need to act quickly if you want to take advantage of it.  Click on the button below to see the offer, then continue.

Breast enhancement is a very personal choice.  Many women, who are not well endowed, have breast augmentation, in the back of their mind, but due to life in general, or cost, they put it off.  Our goal is to remove the cost issue.  If you can get around the "life in general" part, we can help with the rest.

Here is the thing about the cost....in many cases, when you get a quote for an augmentation, they neglect to inform you of the facility fee, anesthesia fee, and in some cases, the cost of the implant.  Our quotes have no hidden fees, it is all out there so you know what you are going to spend.

Here is what you get.  First, you set up your appointment, you can request either Dr Miller or Dr Swetnam.  (If you are healthy and live further away, much of the preparation can be done by email. Just send an email and we can talk there) The consult is complimentary of course.  We talk about what you want, size, implant selection, saline vs. silicone, etc.  The consult will take about 30-40 minutes.  We want you to bring shirts that you want to fill out and when you try on implants, you will have an idea of what you will look like.  We will also discuss the approach (how the implants will be placed).  Of course the size and approach are personal choices but we will help guide you.  Lastly, we will review before and after pictures so you can see our work. We don't play the "trust me" game where you are not involved in the selection process.  You will then get a quote that includes everything.  The fees we charge include the facility fee, professional fee, anesthesia, and implants.  The only other fees will be for the post operative bra, post operative medications which are generally less than $100.

We then pick your surgery day.  You show up, the procedure is performed...takes less than an hour.  With recovery and pre op, about 3-4 hours total time.  When you wake up you will have your post op bra on and you will wear it for about a week.  Of course you can take breaks from the bra, shower, walk around, do most of your normal activity, within limits.  We like to see you soon after the procedure, within the first week (if far away, we have you send some pictures by email) to make sure everything is OK.  We then usually see you at a month and at about 3 months to get pictures for YOUR before and afters.  We will email them to you if you like.  The post operative visits are also included in the fee.

So there you have it.  At Total Body Surgical we are trying to remove the barriers.  All of us worry about cost these days (except Washington..ha) and we understand that.  This is a rock bottom offer that you will find hard to beat so take advantage.  There is only so much operating time between now and April 30 so make sure you get yours!

Call 918-786-7780 TODAY to book YOUR time for YOUR enhancement.  Don't live with regret, this offer may not happen again 918-786-7780, CALL TODAY!!

Breast augmentation....is it too early to get ready for summer 2013???  NOOOOOOOOO!!!  In fact, now is the perfect time.

For most women, the surgery is only the beginning.  It usually takes about 2-3 months for implants to settle and skin to stretch to accomidate the implants.  Why??  Well, let's get into that.

  This young lady is a good example to discuss.  For women who have never had children have tighter skin than those who have not...in most cases.  This makes sense in that their breasts have not enlarged gradually over nine months, then shrunk down after.  When the skin is tight and implants are placed, it takes a little bit of time for the skin to stretch to accomidate them, in some cases, up to three months or so.  The other thing to consider is the distance between the nipple and the fold under the breast.  If you look at this picture, in the 45 degree view, you can see the natural fold under the breast that delineates the breast from the chest wall.  This is the nipple to fold distance.  In women with small breasts, who have not had children, this distance is usually very short.  If you can imagine placing an implant in this breast, the implant will ride high until this skin stretches to accomidate the new and extra thickness of the implant.  After the skin stretches, the implant drops into place giving the more natural look that most women want.

As you can see in this picture, the nipple to fold distance in the first photo is essentially non-existant, in the after photo, 3 months later, the implant has settled, the skin has stretched, giving a nice result.  Again, 3 months later!!

For women who have had children, AND those who have not, when we put implants in below the muscle (the more popular way to place them to decrease creasing and rippling of the implant and skin) the muscle does not like to stretch.  Think about it, when you stretch your muscles, it can be uncomfortable until you put the muscle back into the resting position.  The pectoral muscle is no different.  It contracts in an attempt to resume its resting position as well.  This contraction pulls the implant up on the chest wall making it ride high.  It also takes time for the muscle to stretch and allow the implant to drop.  It seems that the bigger the muscle, the longer the implants lose this battle.  We use massage and a velcro strap to help the process proceed quicker, but it still takes time.

Implants can only be placed one way....through the skin.  Whether they are placed through the arm pit, below the breast, through the nipple, through the belly button, or through a tummy tuck incision, there is still an incision.  For saline implants, about 2 cm (less than an inch) and for silicone, 4 cm (a little less than 2 inches).  It takes a little time for these small incisions to heal.  When summer arrives, with enough time, they are barely noticed.  Not enough time, they can be seen. 

It is now January.  At Total Body Surgical, we always have great pricing on breast augmentation, AND the pricing is all inclusive.  This means that the price includes anesthesia, implants, physician, and facility fees.  The only other costs are for medications, and for the post operative bra that is needed...about one hundred dollars.  If you've been thinking about it, NOW is the time to proceed.  You will look great by March, before the summer outfits are even coming out of the closet.  The implants will have settled, incisions will have healed, and you'll be ready for summer fun.

Come in today or call for an appointment 918-786-7780.  Operating time is filling up quickly so act today!!

Acne can be a terrible affliction or a very minor problem.  It can occur from the teenage years, and also as an adult.  Acne can cause problems that will be present for life, leaving cosmetic issues that may be very hard to deal with.  I want to discuss today the process of the problem and how to handle it.

First of all, what is the process behind the problem???  Acne usually starts in adolesence.  It is a familial problem that manifests during hormonal changes.  It can occur in all skin types and with different degrees of severity.    Acne can lead to social problems that may last a lifetime.  Hormonal increases in adolecense lead to changes in the output of oil in our skin, making it thicker.  This leads to the pores becoming closed, and with bacteria in the skin using this "food" source, they multiply.  The result is the inflamed cystic "comedones" that we call acne. In most instances, the blemishes are limited, resolve in a short period of time, are not severe, and, with the exception of slight embarassment, do no long term harm.  In a minority of cases, the problem is severe, unremitting, and can lead to permanent skin changes.  The changes that can occur are scarring, changes in skin pigmentation, and the resulting self confidence issues that remain. 

What can be done about all of this then?  Most manage by keeping the skin clean and using over the counter products that we see on television.  For minor cases, this is enough.  For more severe cases, these products are no match and the blemishes continue.  At this point, hopefully, parents recognize the severity of the problem and will seek other help.  That is where we can help. 

The first step usually recommend is a change in basic skin care.  We like cleansers that contain salicylic acid.  The salicylic acid in the cleanser helps to liquify and remove the oil that is the root of the problem.  We also recommend benzoyl peroxide solutions that will help reduce the bacterial load.  The third thing I like for patients to do is start a retinol topical cream.  Retinol also helps reduce oil, dry the skin, and compact the stratum corneum, the dead layer of skin cells.  If need be, I will also start an oral antibiotic to decrease the bacteria and decrease the inflammatory response that the bacteria cause.  Antibiotics are generally continued at a low dose as the inflammatory response is less while on them.

For most, these routines are effective in managing the acne.  In others, these steps may not be enough.  The next step I usually add is laser therapy.  We use the Cutera system on a setting that will heat up the skin and kill the actively reproducing bacteria.  There is no recovery time and these treatments can be repeated at 4-6 week intervals with no pain. 

After this step, if no response is noticed, we have a decision to make.  In some women we will add some other medications as hormone modulators such as birth control pills or spironolactone.  If these do not give us results, we then must consider more powerful oral medications.  The one that is the most effective is Accutane.  Accutane is a medication that works very well.  It is also capable of causing problems for some patients.  Everyone has heard of a horror story related to Accutane but few hear of the great number of successes.  The biggest problem a patient can encounter is conception while on the medication.   I-pledge is a program that was instituted to educate patients taking the drug about how to avoid pregnancy and the birth defects that can occur.  Secondly, headaches, brain swelling, depression to name a few are the other side effects than may be encountered while on  Accutane.  The biggest complaints I see are that of dry skin and cracked lips and these are very tolerable.  In most instances the results far exceed expectations and over shadow the risks.  The usual patient takes the medication for 6 months.

My personal philosopy is that the risks of Accutane, when given correctly, are very much worth it.  I am often asked to try to treat patients with scarring and pigment changes resulting from severe cystic acne....this is VERY hard work and is usually only marginally successful.  For that reason, I start off with the less problematic treatments and give them a fairly short trial...6-8 weeks.  If there is no measurable result and the acne is severe, I usually will then suggest Accutane if the patient is a reliable person and can understand the risks.

Come see us today at Total Body Surgical Cosmetic Surgery if you need help....918-786-7780.