Total Body Surgical Blog

A good friend asked me to talk about fillers this week and I promised I would, so here goes.

First of all, what is a filler and why would someone want to use one??  Fillers are just what the name sounds like.  As we age, we lose volume in our face.  We lose it around the eyes, in the cheek area, and in the folds around the mouth and lips.  This is caused by hormonal changes and in many cases, genetics plays a significant role.

  As you can see in this graffic, as volume is lost, the skin begins to respond to gravity and "folds" in typical spots start to form.  Nasolabial folds are the most common, forming around the base of the nose to the corners of the mouth.  Secondly, "bags" begin to form under the eyes.  This is due to shrinkage of the fat pads in the cheek area that, in younger people, "windowshade" the fat pad under the eye.  This creates the dark circle under the eye which is really shadowing, as light is blocked by the overhanging fat pad.  The other commonly effected areas are the "marionette lines" at the lower corners of the mouth and vertical lip lines.  One other common complaint is thinning of the lips and loss of the youthful shape of the lip.

This picture depicts the "cone of youth" and how aging turns it into a box.  Again, most of this is due to loss of volume and loss of skin elasticity.

Now that we have covered what happens, what can be done about it?  There are a few ways we can correct or reverse the aging process.  The first thing I recommend is good skin care.  It wouldn't be right to fix up a vintage car and not re-paint the thing would it?  You want your skin to look as youthful as possible and I think Obagi is as good as it gets for that.

Second, we have to increase volume.  Even when we do face lifts to remove excess skin, most of us will add volume to fill up the upper part of the face...this is youthful.

The first and best way to increase volume is with facial implants.  They are solid silicone and never go away....one time and that's it.  The second best way is with fat grafting.  We use your fat, process it, and place it back in the face.  This is good because it can last a pretty long time...5-7 years.  The third way is with fillers.

Fillers have been around quite a long time.  First came collagen fillers that only lasted about 3-4 months and required skin testing.  We now have them that last a year or more and can be used in anyone.  The most commonly recognized one is Juvederm.  It is made of cross-linked Hyaluronic acid (HA).  HA is a substance that is present between our cells naturally.  Juvederm is clear and almost jelly like.

  It can be used literally anywhere in the face.  We use it to fill the cheek area, the nasolabial folds, marrionette lines, and lips.  It can also be used to correct nasal deformities or acne scars.  Think of it as putting dirt in a hole in your yard without disturbing the grass.  It is used to fill deformities or add volume to the cheek area, the nasolabial folds or marrionette lines.  It can be used to make lips larger or reshape them.    The second type of filler non-occuring in the body and made of a calcium compound mixed with a sugar based carrier.  This filler is good for volumizing but can only be used in deeper tissues. 

Radiesse is great for liquid face lifts where we place volume into the cheek area, lifting the face and restoring volume.  It can be used in nasolabial folds and carefully in marrionette lines.  It cannot be used in lips or in the dermis (skin).  Most other fillers on the market are made of HA, regardless of the name, except Artefill (made of collagen and spheres of solid material) and Sculptra (made of a powder material that causes collagen to form).  These two materials are made to inject deeply and last 5+ years.  All fillers have advantages and disadvantages.  You must consult with your injector to know which one is best to get the result you want.

My preferences are for Juvederm and Radiesse, for shorter term fillers.  I use silikon 1000 for my long term filler as it never goes away.  I use it to make great looking lips that stay.  I do small injections a month or so apart to get the right amount of correction.  Hope this helps everyone.  We love fillers and do them very well.  Call today and come see me at 918-786-7780.  All cosmetic consultations are complimentary.

Possibly more changes on the horizon for weight loss surgery are in the making.   

These changes will have an effect on the entire landscape of bariatric surgery in the U.S.  First, a little history....

When bariatric surgery first started (weight loss surgery) there were few regulations and a multitude of procedures that were tried.  All procedures were done through a large incision and most of the patients are high risk due to their weight and many other additional medical problems brought on by the weight, i.e., diabetes, high blood pressure, heart disease, sleep apnea, etc.  This combination led to a high complication rate and high mortality.  What has changed in the past several decades to make these procedures much safer is the innovation of laparoscopy.  This allows us to do the procedure with tiny incisions, fewer wound problems, much less pain, and shorter hospital stays.  Other changes that have happened are the standards that were set for bariatric centers. These standards were fairly rigid and the procedures done were made more standard.  What we have learned is the bariatric patient needs a higher level of pre-operative evaluation and post-operative care than the average patient.  Because of this, the American Society for Bariatric Surgery was formed and guidelines were created to improve safety and "centers of excellence" were created.  Centers of excellence were formed based on criteria set for pre and post op care, and a minimum number of cases done in a year. 

After gaining experience and analyzing a ton of data, it was discovered that the center of excellence really does not change outcomes.  What this means is you can have a procedure done at a center of excellence or a non-accredited center and have just as good an outcome.  The net effect of the center of excellence has been to limit access for medicare and medicaid patients with no real benefit.

After joining forces, the American College of Surgeons and the American Society for Bariatric Surgery are trying to change (in my opinion for the better) the center of excellence guidelines.  Here is what the proposed changes will look like:

1. Three divisions will be set up, the first being band centers, where only lap bands will be performed.

The Gastric Band on the stomach.

The second division will be "low acuity" centers of excellence.  These are smaller facilities "like INTEGRIS Grove hospital" that have qualified surgeons but limited ancillary services.  These centers will be able to do staple procedures on "lighter" individuals with few other medical problems. In other words, healthier, lighter patients will be able to have their procedure done on a more local basis and not have to travel to big centers.

Sleeve gastrectomy                                               Gastric bypass

In these lower acuity centers, the work up is the same and all of the patients are tracked by a National Data base.

The third division is the high acuity center.  This is where heavier and more complicated patients will have to go, usually in the larger regional hospitals.

This is the proposal that was sent to the CMS (Medicare).  However, they have different ideas about the whole thing.  CMS, looking at the data, thinks that possibly communities would be better served if the whole center of excellence thing was just eliminated.  They do have a substantial amount of data that shows there is no improvement in outcomes.  Now the Politics come in.  What politics?  Well, current centers of excellence don't want any change and centers that want to gain this distinction can't because the number of cases that must be performed, under the current rules, cannot be reached.  The number of people needing the surgery continues to grow and many cannot get to a current center of excellence for care.  My feeling is that if you have a qualified surgeon and a program in place....what difference does it make.  People that need the surgery should not have to travel hundreds of miles, and according to the data, it makes no difference.  Hopefully, a reasonable compromise will prevail....and soon.  Many programs, ours included, are sitting on go, waiting for some sort of direction.  In the mean time, we are limited to private pay patients and private insurance patients currently.  We are looking for some type of decision in 2014 and are hoping for good things.

   Of course the changes will mostly only effect Medicare and Medicaid patients but some private insurance as well.

So that is what's on the horizon...better access.  We hope to be a low acuity center in the very near future as Dr Miller is fellowship trained, certainly qualified, and ready to go!

Our cash prices are pretty good too (see below) and you don't need to travel to Mexico either!!

So come see us today!!  Cosmetic consultations are always complimentary!! The spring laser liposuction special is going on so act now to reserve your time!  918-786-7780 or 1-866-weight0.  And don't forget our low prices on breast augmentation either!!!

Keep an eye out for the news reports on the sleeve gastrectomy!!!

Now that the breast special is over (just so you know, our usual price for saline implants is still the rock bottom price of $3800!) we're going to wear out the liposuction for a while. 

"Lunch time" liposuction.....what the heck is that?  Most people see liposuction as a very violent and traumatic experience, right?  Here is a brief history of liposuction compliments of liposuction.com:

Liposuction has become one of the most commonly performed cosmetic surgeries in the United States. In 1974, Dr. Giorgio Fischer, a gynecologist from Italy invented the original form of liposuction. French physicians Illouz and Fournier further developed liposuction around 1978. By 1980, liposuction was extremely popular in the United States but was confronting negative publicity due to patients experiencing excessive bleeding and undesirable rippling of the skin after surgery.

In 1985, Dr. Jeffrey A. Klein, a California Dermatologist, invented the tumescent technique for liposuction, revolutionizing liposuction surgery. His “Tumescent Technique” allowed patients to have liposuction performed totally by local anesthesia using much smaller cannulas. Patients could now have liposuction surgery without the fear of excessive bleeding and undesirable skin depressions.

Here you can see the tumescent fluid (numbing medicine, saline or salt water, and a vasoconstrictor) being injected into the fat layer.  This provides anesthesia for the area and helps to minimize bleeding.  Of course, there is a limit to how much lidocaine we can use based on the patients weight and this limits the number of areas we can do at any given time.  Even though larger areas can be done, we do them all the time, smaller areas are perfect for this technique.

We also use some sedation when doing larger areas to limit the amount of discomfort while the fluid is being injected.  We then allow some time to pass so the fluid has time to work.  Once the local anesthetic takes hold, we start the procedure.  For most cases, we use the Cool Touch laser to break up the fatty tissue and warm the skin. 

Warming the skin promotes new collagen formation, causing the skin to contract to its new position and tightening it.

We then use hollow cannulas to remove the liquified and non liquified fatty tissue. 

This is a picture of a selection of cannulas in different sizes or diameters.  The fat is suctioned out of the body, into a cannister, and discarded. 

Once the fat is removed, it takes a few weeks for the swelling to go down and a few months for the skin to contract to its new position. 

How painful is it??  This is everyones fear of course.  For small areas, the discomfort is minimal, usually only putting in the tumescent fluid causes a minor amount.  For larger areas there is some pinching around the edges usually and this is why we use sedation.  People walk in and walk out, usually going home to rest after.  After treatment of small areas, most people can return to work the next day and for larger areas, patients return to work after a few days or a week at most.  You will be sore (like you did a very vigorous workout) for a few weeks and of course, the more you move around, the shorter the sore period is. 

What you do after consists of a few things....first, exercise.  Opinions differ but I like for patients to start stretching and massage after a week or so and resume normal exercise after about 3 weeks.  Personally, I like for patients to wear a "spanks" for a month or so after large area liposuction.

I think it really decreases discomfort and bruising.  Most people complain of an itching feeling on the skin over the treated areas as the nerves recover.  My feeling is that the compression helps this sensation as well.

That's all for this week!  Make sure you look at our liposuction offer...it is really a good one.  If you have saddle bags, fluffy inner thighs, or any other area you simply cannot get rid of, give us a call today to schedule your complimentary consultation.  Our pricing is the best. 

918-786-7780 or 1-866-weight0

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!!

I started working in the yard last weekend.  It was warm and sunny.  While I worked, I noticed that the trees are budding out, and there were even a few with some juvenile leaves showing up...guess what...the warm days of summer are nearly here!!  While we talk about hair and skin, don't forget about our breast augmention special, hit the button below to get the details.

This week I wanted to cover a couple of old subjects...skin and hair.  With summer rapidly approaching, these are two of the things that you can improve quickly and get ready for summer.  So what can you do??

1.  Hair.  Most women (and some men) don't like hair in certain places.  This includes the bikini area, underarms, face, and legs in women, and chest, back, and underarms in men.  What can we do about this?  Have you ever shaved in any of these sensative areas and wished you didn't have to? Or, at the pool, notice that you SHOULD have?  That hair is hard to tuck in!!  What about getting waxed, and with tears in your eyes, thinking, there has got to be a better way than this to get rid of this hair!!  At Total Body Surgical we can rid you of this problem for the rest of your life....AND....with unbeatable pricing, not break the bank.

We use the Cutera system to do our laser hair removal.  It is one of the few systems that is FDA approved to treat all skin types and it is very effective.  We expect to get rid of 80-90% of the hair completely and what is left is spindly, light, and weak if there is anything.  Of course the hair has to be darker for us to treat it because that is how the laser works...the dark hair transmits the light energy as heat into the follicle, killing the hair stem cells.

As the population of these cells decreases, the hair becomes thinner and thinner until eventually, it is gone. Body hair generally takes about 6 treatments and facial hair, because it is thinner and transmits less energy, about 9 treatments.  The darker and coarser the hair, the quicker it goes.  The treatments are spaced about 6 weeks apart and generally take about 30-40 minutes.  We use numbing cream and let it set about 20 to 30 minutes before the treatment.  If you do not want to numb it takes less time of course.  Everyone is different so some like the numbing and some don't.  We use the Zimmer cooling system so the discomfort is minimal even if you don't numb.

Remember, hair has to be there for the laser to work.  This means you must wait six weeks after waxing or using a cream hair remover.  You can trim or shave the areas being treated so it does not have to be long and embarrassing.

The way we do areas is like this....the face is considered an area, the underarms is considered an area, the bikini is considered an area.  The legs are considered 4 areas due to the large size so lower leg front and back is 2 areas, thigh front and back is 2 areas.  The abdomen upper and lower is 2 areas and the chest, upper and lower, is 2 areas.  The back, upper and lower is condered 4 areas as well, divided as the abdomen and chest are.

Be sure to click on the hair removal button above to see how affordable hair removal really is!

2.  Skin.  Most skin issues, i.e., pigment changes, are due to UV (sun or tanning bed) exposure.  In women, hormonal changes also contribute.  These changes have many names....

melasma 

poikiloderma 

Of course, they occur on the sun exposed areas of the face, chest, neck, and arms.  If you have these areas, they will usually NOT resolve by doing nothing.  What do we advise??  First, sun protection.  No matter what we do, if sun exposure continues, these areas will return.  Sun screens, hats, and cover ups are critical to the success of any therapy and once you have that covered, we can start addressing the problem.  Basic skin care is critical and the product we recommend is Obagi.  Created by a Dermatologist the line is medical grade and is VERY imitated.  It contains medical concentrations of tretinoin and a lightner.  The kit we recommend also contains the products to manage the pH of the skin, making the medicines work better.  Compared to other products, it is very affordable.  After a few months you will see the skin looking healthier and the discolorations decreasing.  For faster results, or for areas that are a problem, we use Pulsed light treatments.  These treatments target areas of pigment and cause them to peel off quicker and also help turn off the cells that are creating the pigment.  It usually takes a series of treatments along with the basic skin care.  I feel like the best sun screens come from the Skinceutical line of products.  They were also created by Dermatologists and come in many strengths and even in a water proof formula. 

So, get your skin in shape for the coming summer, AND, get rid of your razor!!

Call today to book your treatment or consult 1-877weight0 or 918-786-7780.  There are about 40 days left in our breast augmentation spring special so don't delay...ACT NOW!!

What does Bravo have to do with gastro-esophageal reflux disease??  Well, let's investigate it a little.

What is GERD (gastro-esophageal reflux disease)?? Here is a good definition: 

GERD is characterized by symptoms and/or tissue damage that results from repeated or prolonged exposure of the lining of the esophagus to acidic contents from the stomach and occurs when the lower esophageal sphincter (LES) does not seal off the esophagus from the stomach.

The two most frequently reported symptoms of GERD are heartburn, which can be described as a burning discomfort that begins behind the breastbone and radiates to the neck and throat, and acid regurgitation, which is characterized as a bitter, sour tasting fluid. One out of five people experience heartburn or acid regurgitation on a weekly basis and two out of five people experience heartburn or acid regurgitation at least once a month.

This is a good depiction of how reflux occurs.  The esophagus is not prepared to handle the exposure to acid that the stomach is.  The "heartburn" that can occur is normal on occasion, but if it occurs frequently, it can cause changes in the lining of the esophagus... esophagitis. Besides the symptoms this can cause, I.E. heartburn, chest pain, hoarseness, coughing, bad breath, inability to sleep, it can cause strictures in the esophagus, difficulty swallowing, and changes in the cellular lining that can be dangerous.

Fortunately, today, we have medicines that are very effective in reducing the acid and the symptoms that it causes.  These medications are readily available, even over the counter, but, they are not meant to be used for a long time.  They also have a dark side.  PPI (proton pump inhibitors) like prilosec, nexium, etc., when taken for the long term can cause calcium leaching from the bone leading to osteoporosis or thinning of the bones.  They can also cause changes in the lining of the stomach leading to polyp formation.  They can also be very expensive!!

So, what can be done about this!!  When I see a patient with symptoms of reflux, the first thing we like to do is document any changes to the baseline by looking with a scope...an EGD.  This allows us to look and biopsy to establish any changes.  The procedure takes about 15 minutes under sedation...pretty easy.  We then start a trial of medication which usually works.  It is recommended that the trial is relatively short...a few months...  If symptoms persist we will then schedule for a BRAVO pH monitoring test after being off of the meds for about a week.  This allows us to rule out other causes for the symptoms you are experiencing.  The Bravo is a small monitor that adheres to the esophagus for a few days and monitors the acidity.  You keep a journal of symptoms while we monitor...symptoms and acid=a positive test. 

With a positive test, changes in the esophagus, and symptoms on the medication, we recommend a laparoscopic repair.  This is called a Nissen Fundoplication (hiatal hernias are also repaired at the same time).  If the medications alleviate the symptoms, and you have been on them a long time....we have to decide if surgery is appropriate.  Considering the fact that the medications can cause problems, if you are healthy, patients usually opt for fixing the problem to get off of them medication.

The success rate for the Nissen is about 90%, as reported in the literature....there are not many treatments that have statistics that good!!  You will usually spend one night in the hospital and are back to normal in a couple of weeks with only small (1/4 inch) incisions.

So, the Bravo is a great test to help us figure out if the symptoms you are having are actually caused by your GERD....that's important.  The worst thing we can do is fix your reflux and later find out your symptoms are from something else!!

Come see us today if you have reflux that does not respond to medications, or, if you have been on the meds for some time and cannot live without them...WE can help.  We do EGD, Bravo pH testing, AND Nissen Fundoplication, Total Body Surgical!

Call 918-786-7780 or toll free 877-weight0 today for an appointment!!

Don't forget our special pricing on breast enhancement surgery until April 30..what a deal!! Just click on the breast button to see what it's all about.  AND our liposuction special pricing too, look great for summer!!  Cosmetic consultations are always complimentary!!