Total Body Surgical Blog

Let's have some fun today.  It's been a little while since we had a little audience participation and I think it is time to change that.  Sooo, it's test time again!! 

Here are the rules:

1.  Look at the picture and see what you think would help.  (those of you who come here often will find it easy...you are educated!!).

2.  The choices will be between using Botox, a Filler of some sort, laser, or a surgical procedure.

You may elect to combine the use of these tools and that is OK.  I do it all the time.  Today though, let's not get too complicated.  In my analysis of the patient I will give you some ideas on what other things would be good for the patient.  I need to feel useful in some way!!

Always remember, there is no right answer, because, in Cosmetic surgery everything is elective.  You can always choose to do nothing.  However, there are wrong answers.  Wrong answers are when you plan to do more than the patient needs or wants.  My job is to steer people away from unecessary procedures and only do what's needed or desired...today, that's your job.  Good luck!!

Example #1: 

Here we have a 40'ish female with no other medical problems.  She complains that she looks "old" and wants a face lift or something to help her look the way she feels.  Look at her closely.  What do you think??

What would you recommend:

1.  Botox  2.  some type of filler  3.  laser  4.  a surgical procedure

Example #2:

40'ish young lady who complains about the lower part of her face sagging.  Her friends have told her that you have helped them and she should come talk to you about what could be done.  You would recommend???

  Your recommendation??

1.  Botox  2.  a filler of some type  3.  laser  4.  a surgical procedure

Example #3:

A 54 year old lady who is disgusted with her neck and just thinks she looks OLD!!  She says that cost is no obstacle and wants it all fixed, or injected, or something! 

 And the winner is....

1.  Botox  2.  some type of filler 3.  laser  4.  a surgical procedure

Example #4:

28 year old female who states her boyfriend says she has "wrinkles around her mouth".  She is concearned about this and wants to know what you think....

  Here she is...

1.  Botox  2.  Some type of filler  3.  laser  4.  surgical procedure  5.  get a new boyfriend!

Example 5:

A 65 year old widow comes to you and says she has finished mourning the loss of her husband and wants to look younger so she can "get out there".

  Very nice lady....funny too....what would you recommend??

1.  Botox  2.  some type of filler  3. laser  4. Surgical procedure  5.  Birth control

Well, let's see how you did.  On number one if you said Botox, that would be a great start.  Most people want to start small.  Botox would get rid of the lines around the eyes and in the upper face.  She will eventually probably want a brow lift to eliminate the lines and the cause of them but Botox is fairly cheap and less invasive.

On number two, I would say Botox and some type of filler.  This combination is great for softening wrinkles in the upper face and getting rid of nasolabial folds as this lady has.  She has good facial structure and her skin is in good shape.  This will make her very happy and not cost a fortune.

On number three, I would recommend a surgical procedure or two.  Looking at the "hooding" over her eyes, she would benefit greatly from a brow lift.  It will take years off of her appearance.  She also has the "turkey gobbler" neck and jowling but her neck is not heavy.  I would recommend a mini lower face and neck lift as well.  She will be very happy!

On number four....get a new boyfriend of course.  We see people like this sometimes and my job is to DO NOTHING.  She needs to be told how beautiful she is and just how silly it would be to do anything to change that.  Unfortunately, in many cases, these people will find someone to mess things up.  It's sad.

Number five would need a brow lift, upper eyelids, face lift, and I would also recommend full face laser to treat the discolorations and fine lines on the rest of the face.

I hope you did well on the quiz today, and enjoyed using your own evaluation skills.  If you like, let me know how you scored and if you have anything you would like addressed, send that too.

Call us at 918-786-7780 or 1-877-weight-0 to make an appointment.

Why Botox???  Well, look at my picture...see any lines??  Do I look fake or funny to you??  I don't feel funny!!  The best way to summarize the answer to the Botox question is...it makes you look younger.

If that's what you want, Botox is the medication for you.  As we age, the muscles of facial expression work day after day.  Our surprised look, our concearned look, our mad look, and squinting from the sun or when trying to read all lead to eventual wrinkles in the skin.  We get crows feet, lines in our forehead, elevens between the eyes and so on.  This happens to everyone whether we like it or not.  As these lines appear, sometimes as early as the 3rd decade of life, they start to show our age with only a glance.  These lines are difficult to hide with cosmetics and may not only show your actual age but may make you look older than you really are.
  Don't be depressed, have a low self esteem, and lose your confidence, DO something about it!!

What we have today is a whole armamentarium of therapy to make you look your best every day.  Botox is the product I want to talk about a little.  First of all it is very safe.  It is next to impossible to have a severe complication from Botox.  The safety profile is excellent.  It has become very affordable as well.  Usually the cost for treatment of the upper face is around $300.00.  This will generally get the forehead, the elevens between the eyes and the crows feet.  It is very quick and simple to do.  We use the smallest needle we can find and use the highest concentration so that bumps after injection are usually non-existent.  There is very little discomfort and it takes about five minutes.  About the worst that can happen is a small bruise which is rare unless you are taking aspirin or ibuprofen.

  After injection we have you briefly hold pressure on the areas and exercise the muscles we have treated.  In 3-5 days or less the wrinkles will soften and many will disappear.  The effect usually lasts for 3-6 months and for this time, the muscles are weakened and cannot crease the skin as badly.  It does not paralyze the face or make you look "funny" if done properly.  You will look refreshed and younger as the wrinkles fade.  When the strength in the muscles creating your wrinkles starts to return, you will notice the change in the skin and then return for re-treatment.  Most people have 2-3 treatments per year.  After you quit paying for wrinkle creams that do not work and cosmetics to hide the wrinkles that are marginally effective, it is a good investment.  If kept up with, you can go wrinkle free for years and if you keep up with good skin care as well, you will be miles ahead of the game.

Come see us today at Total Body Surgical, we are specialists at Botox and all other aspects of Cosmetic Surgery.  Also Click on any of the flags to see specials.  Mention this blog and get Botox for $9.00/unit.  Call 918-786-7780 for a visit today!!

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!!

I want to spend some time discussing lasers and how we use them today.  Lasers have been around for some time.  In the past, at least as far as medicine is concerned, they have been a technology looking for an application.  In the past several years, improvements in technology have made them much safer and applications have greatly increased.

  Austin Powers....demonstrated his ignorance of laser technology.  Lasers have been a mystery to most!! 

Laser and intense light or flash lamp therapy are both based on concentrated light.  Let's talk about lasers first.

Lasers are concentrated light that can be used for multiple applications.  They have been used in industrial applications for years. Medical lasers have numerous applications as well.  We use them to to clear up and make skin look prettier.  We use them to remove tattoo's.  They are used to treat veins and vascular problems on the body and face, even varicose veins.  We can remove unwanted hair, laser fat cells, make skin contract, use them to cut skin, and now we can treat toenail fungus which has been a nagging problem.

Pulsed light therapy is based on a bright flash of light shot onto the skin.  Also called a flash lamp, this technology has been used for other applications, photography, etc.  In cosmetic surgery we use it to treat spots and different pigments on the skin of the face or body.

Unfortunately, there is no single laser that can be used for all applications.  Not to get too complicated (because it is complicated) the way we choose what laser or lamp to used is based on the chromophore we are trying to treat.  A chromophore is the part of a molecule or cell that produces its color.  Each laser or flash lamp has a wave length that attacks that color.  This is why one laser or lamp will not work on all colors.  We know what colors we are trying to treat and select the laser or lamp that will work on that specific color.  This is where the art meets the science.  With some applications, we are aiming at water in the skin as the chromophore, especially when resurfacing the skin. 

The most common laser currently used in Cosmetic Surgery are the nd-YAG, the KTP, the CO2, and the pulsed dye lasers.  Each of these target a different chromophore or color.  The newest developments in the technology is the fractional and q-switched technologies.  We used to resurface skin by ablating or lasering the entire skin surface.  Since the skin recovers by healing from the hair follicle, recovery was slower than desired and this scared people.  Fractional lasers give us the ability to divide or fractionate the pulse of light from the laser.  This leaves islands of undamaged skin between the areas treated.  There are more and larger areas for the skin to heal.  The advantages are that healing is much faster and complication rates are less.  The disadvantages are that the treatment is not quite as good and may require more than a single session.  Q switching is a way to modulate the laser output to get a better "quality" of light energy, more intense output per pulse.  I will talk more about Q-switching when I discuss tattoo removal.

Flash lamps also treat specific colors in the skin.  They are used for treatment of brown pigment, red pigment, and hair in the treatment areas.  With flash lamps, we must change the wavelength of the light to treat each problem.

Now that the boring part is over, next week we will begin to explore the problems we treat and what we use to treat them.

Don't forget our nail fungus, lap band, and liposuction deals that are currently running.  We also are having multiple Botox events in Tulsa and Grove to get everyone ready for the holidays!!  Send me a message, fill out a contact form, or call 918-786-7780 to find out when and where.

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!

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

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

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

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

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

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

One of the most common fillers is Juvederm.

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

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

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

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

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

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

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

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

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

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

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

A third area is around the mouth.

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

Another off label use is for Masseter muscle enlargement.

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

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

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

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

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

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

Watch this video for a little laugh....

http://youtu.be/nB7wtLMsm5c

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

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

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

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

Here are the facts:

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

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

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

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

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

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

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

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

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

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

I hear you....OK....it has been a lot of information on skin...I know.  This will be the last installment on skin, at least for a little while.  I am going to talk a little about skin color changes or dyschromias.  No YouTube this week...couldn't find a good one for ya'll.

What causes dyschromia in our skin??  The same old things...too much sun and poor skin care habits.  Added to these problems are hormone changes, rosacea, venous changes in the skin, skin thinning with age, etc.  All of these problems create the browns and reds that become apparent as time progresses.  The terminology for dark spots are poikiloderma or brown spotting that usually occurs on the chest after years of tanning and melasma or brown discoloration on the cheeks and face in a mask like distribution.  Melasma can occur in younger women during pregnancy and is certainly related to hormonal changes with pregnancy and menopause.  When the sun is added to these changes, it can be dramatic.  We also can get vascular changes in the face.  The most common areas are on the cheeks and around the base of the nose.  Here you may see visible veins, small cherry red spots, even a generalized redness.

After identifying the changes, what can we do about them?

There are many approaches and all of them begin with good basic skin care.  I recommend some type of retinol cream and a topical vitamin C along with this.  To help tame those brown spots I also add hydroquinone to turn off the melanocyte that produces the pigment.  Retinols are vitamin A compounds that help thin the "dead" layer of skin and stimulate growth of new skin.  Over time they make a big difference.  Sun screen is also crucial to help stop the damage.  At Total Body Surgical, we use the Obagi system because they are pharmaceutical grade and make a dramatic difference over time.

After taking care of the basics we can address the color issue with lasers and Intense Pulsed Light or IPL.  The IPL is a flash lamp system with wavelengths that target the pigment we want to get rid of.  The reds are diminished and the browns crust off while turning off the melanocyte.  IPL treatments are usually done in a series of 3 to 5, about a month or so apart to be successful. Vascular lasers are used to treat hemangiomas, visible veins, and larger red spots. These treatments can be combined with milder forms of laser skin resurfacing.  At Total Body Surgical we use Cutera technology.  This system has the Limelight IPL system that is good at treating multiple pigments in the skin.  We also have the Pearl which is mentioned in this segment,

http://youtu.be/0goYcY3LTqQ

The Pearl is a good way to get immediate results with the added benefit of "buffing" the skin.  This creates a new skin feel that is softer, recreating that glow that is age defying.  The treatments can be "stacked" on each other to get the benefits of both.  When used for treating pigment, recovery times are usually no more than 4 days.

Well, that about covers the face.  From facial skin care to face lifting and implants.

We have extended the breast augmentation special pricing through July so don't miss out, -Breast Aumentation....ACT NOW!!!

I am also working on a special Pearl package for the fall (you should not be tanning when we do it) as this is the perfect time to start.

Next week....tackling obesity with the Lap Band!!!

If you would like to have this blog emailed to you, please sign up on the contact page. 

Also, if you like this, like us on Facebook!!