Total Body Surgical Blog

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.

Get ready for summer???  What!!  That's right, this summer for all intents and purposes is OVER, it is now the time to consider what changes YOU want, and do them before it is too late for the next go around.  There are things that you can do in fall and winter to be ready for lake, swim suit, and beach wear.

The first thing to consider working on are things you have a hard time hiding.  Spider veins or varicose veins are two of the big things.  I will talk more about options for treatment in the coming weeks, but, to have a great result and be ready for shorts and skirts, it takes time.  The areas have to heal and may require several treatments.  During fall and winter, long pants conceal treatment in progress....now is the time to start.  Call to schedule..918-786-7780.

The second thing to consider is your complexion.  Now is the time to get started on a good skin care regimen to reverse summer sun damage and keep that skin glowing through the winter.  We love the results we see with the Obagi line of skin care and for those that need an extra kick, we use the Pearl laser and IPL to get rid of dark spots, fine lines, and wrinkles.  The Pearl laser is fantastic for fine lines, wrinkles, and improving skin tone, color, and texture.  It also comes with one of the shortest recovery time of all ablative laser treatments.  Treatments in the winter will get you ready for next year...call today 918-786-7780.

The third thing, the second concerning lasers, is hair removal.  With the lowest prices in the 4 state area, now is the time to get that unwanted hair GONE.  Start now and stop shaving those sensative swim suit areas for good.  With our pricing, you'll make money not buying those expensive razors....call today 918-786-7780.

Fourth...breast augmentation.  Even though recovery time is fairly short for an augmentation, it is nice to get that over in the less active winter time.  We can get you the look you want at a very fair price with short booking times.  Call today for your consultation and book your time early.  Restore your confidence next summer in swim wear...918-786-7780.

Fifth...liposuction.  Have that abdominal pooch, love handles, or are you unhappy with your thighs?  For the right people, liposuction is life changing.  Problem areas that won't go away with exercise and diet can be sculpted into the form you are looking for.  We have laser technology that can tighten skin as well.  It takes time for the skin to tighten after laser liposuction so now is the time to get going.  Consults are complimentary so call today..918-786-7780.

Sixth...toe nails.  Many people are embarassed by their feet....toe nails in particular.  Many of us have nail fungus that makes the nails thick, yellow, brittle, and discolored.  Medications are 50% at best for curing the problem but come with many risks your liver.  Laser Genesis has been FDA approved to treat the problem and is over 80% effective with only two treatments.  It does take time for the sick nail to grow out.  Do it now and get your two treatments out of the way, new nails...next summer....sandals!!!  Call today 918-786-7780.

Of course there are many other things that you can do and it is always better to recover in the winter, tummy tucks, eyelids, facelifts, and more.  The other thing that you can do to re-invent yourself is the lap band.  If you are overweight and diets continue to fail, the lap band may be for you.  If you do it soon, you could be fifty or more pounds lighter by next summer...would that be amazing or what!!!  Book today 918-786-7780.

So there you have it!!  My advice is to start preparing for next summer NOW.  Don't wait or you'll miss it.  We want to help and we have the skills and people to make it happen.

Call today 918-786-7780!!

Last week we discussed how Botox can be used to prevent some wrinkles and soften others.  It is a great product and is now more affordable than ever.  Today I would like to briefly discuss what to do about those wrinkles that won't go away with Botox or those that Botox is not appropriate for....what can we do with them??

The most common complaints I see about facial appearance AFTER Botox have to do with residual wrinkles or sunken spots around the mouth.  Here is a common picture that shows and labels the areas we are discussing.  As we age, the face loses volume..ie fat.  We get it where we don't want it and lose it where we'd like to keep it....go figure!

When the volume is lost, of course the skin falls a little creating a hollow area.  When not too severe, these areas can be helped tremendously by replacing the volume with either harvested fat or some other material.This picture demonstrates a before and after of a nasolabial fold filled with Radiesse....Nice result I think.  The area is softened quite nicely.  This is done in the office with very little discomfort and an immediate result.  We could also use Juvederm in this area.  Both fillers last a year or more and there are few problems with them.

Another area commonly complained about is the Marrionette line area.

  Here we see in the before picture how the nasolabial folds are prominent and the marrionette lines are too.  These lines are present at the corners of the mouth and cause the lip corners to turn down.  When filled, the result is pretty amazing.  You get a much more youthful appearance with no surgery and no recovery time.

  A third area complained about is the glabellar area.  Botox works to soften this area but when the lines persist, it is a great place to fill.

These three areas are the most commonly treated spots that we use fillers on.  At Total Body Surgical I use Juvederm and Radiesse.  I think they both work very well.  As I said, they both work for about a year.  We do injections in the office and it takes very little time.  There is no recovery time and the worst problem that can arise is a bruise. 

At Total Body Surgical we have a great deal of experience with many fillers.  For the remainder of the summer we will offer a special on fillers.  If you pay full price for one syringe you get the second one at half price.  That means you get two syringes for $775 and Botox for $9 per unit if you mention this blog.  I use Botox with fillers as it helps them last longer.

We look forward to seeing you soon.  Call 918-786-7780 to set up your time!!

Click on one of the buttons to see other specials currently running.

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

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

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

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

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

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

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

http://youtu.be/kceaEMmi7pA

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

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

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

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

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

Talk next week!!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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!