Total Body Surgical Blog

Thought ya'll might like a break from the breast this week!  I guess you can have too much of a good thing, BUT, don't forget about our spring breast deal...hit the button above to check out our offer, it's a good one!

After a cold winter of intermittent goody indulgences (think Christmas and New year) and less sporadic exercise, the question is..... are you going to be ready for Summer?  Would you like a jump start to a new and healthy lifestyle?  Are there areas on your body that despite all the exercise and dieting in the world, simply will not go away?  You can blame that on your genetics, baby.  Unfortunately, we can't pick our parents, so what options does that leave us?

Thin girl with "saddle bags"...genetics in action.

The answer to that question is liposuction.  You may also hear the term "body contouring" , the terms are interchangeable.  Many of our patients who undergo liposuction body contouring improve not just their confidence, self esteem, and overall quality of life; but also comment on their new and increased volition to exercise and maintain their body in a positive fashion. At a far more drastic end of the spectrum, we have had others comment that a simple body contouring liposuction procedure has allowed them to experience and achieve goals that their appearance or body shape has prevented them from achieving in the past. 

love handles...spare tire

Men often collect and store their fat over their abdomen, breasts, and neck, whereas women will collect it in their waist (the dreaded muffin top), their abdomen, arms, and thighs.

"Muffin top"...funny but true.

So you're asking, what does this entail?  "I've seen it on TV and it looks soooo rough and painful."  Guess, what?  Things have changed.  Drastically. At Total Body Surgical, we use a technique that was popularized around 2005 on the West Coast called, laser lipo, lunchtime lipo, smartlipo, etc.

CoolTouch laser used at our facility.

Essentially, the process involves three steps.  The first part is the hardest step and takes the longest time.  What happens is numbing medicine (lidocaine with saline mixed) is placed into your areas of concern.  Once you are numb, the next portion involves using a laser to go in and melt the fat.  The laser also serves another really beneficial purpose... it helps to shrink down the skin.  Ok, that being said, we need to take a side trip and discuss this whole saggy and loose skin thing.  Picture a  10 pound sack of potatoes.  If you took 9 pounds of potatoes out of the bag, you'd have a heck of a lot of sack left over, right?  This is the same concept with your body and liposuction.  If we go in and remove a batch of fat from an area, it's inevitable that you're going to have some extra skin.  Now, whether or not that skin is going to snap back depends, once again, on your  genetics.  We only have so much elasticity to our skin.  As we get older, have babies, and yo-yo diet, all these factors act to decrease the amount of give and elasticity to our skin.  It's kind of like your favorite pair of socks that ends up around your ankles at noon time because the elastic has given up.   The laser helps to counteract this somewhat.  As I stated already, the overwhelming factor of whether your skin will shrink down or not completely depends on your genetics, but the laser certainly helps to optomize the situation.  Lastly, the third and final step to the procedure is the fun part.  This is where we insert a tiny tube underneath your skin and suck out all the melted fat.  This is where you lose your inches and get rid of that darn fat deposit.

Now, take into account that you will retain water and be swollen enough to not allow you to see your final appearance for about 12 weeks.  That means, getting ready for Summer and planning ahead is essential.  Make no mistake, Spring is peaking its head above the covers, and Summer is just around the corner!

Beside the breast augmentation special we have going this spring...we always have great deals on liposuction!  Check it out by hitting the lipo button.  Remember that Cosmetic Consultations are complimentary, so what have you got to lose???  Call 918-786-7780 TODAY.  Financing also available.

Tired of hearing about the breast???  This week I want to talk about the less than perfect breast that some women develop.  I know many of you women are tired of hearing about the perfect breast that is just a little small and can be made better by implants.  What about the breast, due to genetics, or abnormal development, cannot be helped by implants alone??  Let's talk about that today to give you a break!  However, I don't want you to forget about our breast enhancement special...it only lasts until April 30 so you have to act quickly.  Click the button below to get the details!!

Let's see how the breast develops normally, then we'll have a better appreciation for how these deformities can occur.  Then we will cover how we fix them to make the breast look more normal.  The normal breast is stimulated to form by female hormones that begin production at menarche or the start of menstruation. The picture below shows the normal progression of the breast as it grows from a bud that men AND women have.  Again, it is the female hormonal soup that causes them to form.

Of course it is very rare for both breast to form exactly the same.  Perfect symmetry in the body is rare, so each breast is different, even in the same person.  This is why some women have difficulty finding a properly fitting bra.  There may be a half cup difference between sides.....this is not abnormal....just aggravating!  Here is a picture of different breast shapes and sizes.  This does not include all types of course, but it gives you an idea of how many variations of normal there are and also includes some of the abnormal breast shapes.

 (the "perfect" breast shape is a misnomer of course)

As you can see from the first picture, the breast bud starts first and develops concentrically, widening to form the breast mound.  If this concentric expansion is retarded, the breast forms as a tube, making the very constricted and abnormal looking.  The function of the breast is also retarded and in most cases, breast feeding later in life is not possible.

 This picture is a depiction of tubular breasts of different severities.  It is the mound of the breast that is constricted and does not spread out, therefore, the tubular shape of the breast. 

The other feature of the tubular breast deformity is a herniation of the nipple.  Normally, as the nipple and areola develop, they are "puffy".  The nipple is puffy until the breast mound spreads out.  As this happens, the nipple-areolar complex flattens to create the more "normal" appearing breast as a whole.

 Herniated "puffy" nipple.

So now that we know what a tubular breast deformity is.....what can be done about it?  To fix this problem properly, we must address several issues.  First, is the nipple herniation.  Fortunately, fixing the nipple also gives us access to the rest of the problem and allows the entire fix to be done through one incision.  We use the peri-areolar incision to make the nipple smaller and to allow access to the tubular, constricted, breast tissue below.

 This incision allows us to reduce the nipple size and when closed it flattens the nipple and areola into a more normal appearance.  The constricted breast is broken up below so that it is no longer in a tube shape and lays flatter. 

The last step is augmentation.  Since the breast only formed centrally, there is generally very little volume.  This can only be corrected by adding volume with an implant.  We place the implant below the muscle and through the same incision.  Saline implants or silicone implants are used as there is no difference in the result...again...it is personal preference.

The results are generally very good.  It does take some time for the skin to stretch and accomidate the new volume.  There also may be some creasing of the skin, usually the lower part of the breast, due to its tight adherence to the chest wall, that may take some time to stretch.  This skin may never stretch fully.  The goal is to get as near a normal appearing breast as possible.  This is not always achievable but any improvement is usually greatly appreciated.  The incisions heal nicely and the recovery time is about that of a breast augmentation.

 Good representation of tubular breast deformity repair.

Come see us today for all of your Cosmetic surgery, Vein surgery, Obesity surgery, and General surgery needs.  All Cosmetic Surgery Consults are complimentary, call 918-786-7780 or call toll free 1-877-weight0.  Be sure to take advantage of our breast augmentation special through April 30!!!!!

Boobs and Boats!!  Crass?  Shocking?  Well, it's not meant to be, but I sure got your attention, didn't I?  Here in Grove, we are welcoming the Bass Masters Classic this week, essentially the Super Bowl of fishing. With that, we are also having our annual boat show in town.  To many, boats means the lake, and the lake means sun and fun. 

 Summer fun!!

It seems that even though there was snow last week, Memorial Day is just around the corner.  Boats mean swimwear, sun tan lotion, strapless dresses and other summer wear.  This is the time many women think about breast enhancement.  That leads me to discuss our focus for the next 2 months: breast augmentation, AKA boob jobs.  Why are we focusing on this, you might ask??  If you didn't know, spring time is our breast enhancement special time.  Of course we are pretty affordable year round but in the spring, we pull out all the stops and try to make breast enhancement as affordable as possible. Hit the button below to get the details....

With a summer spirit in my mind, if you are considering breast enhancement, here are some things to think about. There are generally three categories women want to fall into after augmentation: 1) One that only the woman and her significant other notice. A very small change.  In this situation the desire is only improved shape and not necessarily size. 2) The second type is one where a difference is noticable but not over the top, enough to turn a few heads.  Essentially, enough to fill out a bathing suit, accentuate a nice summer top, or just make shirts fit better.  3) The third type is one that stops traffic.  Typically uncommon, we certainly try to  accomodate all wishes.  The bottom line, we want YOU to pick the size and shape that you feel most comfortable with.  Sure, we'll make suggestions, but ultimately, it is your body.  

The process is fairly straightforward.  After discussing with you what it is you are looking for, we will have you use a sizing bra, and place actual implants within it.  Bring your favorite top to try on over this bra if you like.  Take as much time as you need.  Once a size is found, we then discuss what incisions you'd prefer.  There are four types: through the nipple, through the armpit, through the bellybutton, and underneath the breast.  The nipple or peri areolar incision is not something that we recommend, as the scar is visible plainly when viewing the breast from the front.  Making the incision through the armpit hides the scar, but it can be a bit more painful than the other types on incisions.

 transaxillary incision

Placing the implant through the bellybutton has really fallen out of favor because the higher likelihood of abnormal implant placement, and the fact that silicone implants cannot be placed this way.  The incision made underneath the breast is well hidden, and the least painful.

  inframammary incision

We like placement through incisions under the breast or through the armpit but we can place them through any approach.  If an implant ever needs to be replaced in the future, it is always done through an incision at the bottom of the breast. Next, we discuss placing the implants above or below the pectoralis muscle.  When possible we like to place them below the pectoralis muscle.  It gives the implant more support, and looks more natural.  The best way to think about it is like a natural bra.  Placing the implant above the muscle has less support, and gives more of a "stuck on" appearance.  We place implants above the muscle when a breast is borderline needing a lift. Next, our consultation will turn to the type of implants.  We offer two types: saline and silicone.  Both have their positives and negatives which we will discuss with you at your consult.  It really boils down to personal choice.  The saline implants are a little bit cheaper in price than the silicone.  The feel of the two types is distinctly different. The saline feels a bit more like a water balloon, which is essentially what it is.  It's a bag filled with salt water.  The silicone feels a bit more like actual breast tissue. 

http://youtu.be/kceaEMmi7pA (video showing the inside of a silicone breast implant)

The leak rate of saline implants are a little higher than the silicone implants- there is a 2% chance per year collective risk of having a leaking implant.  That means, at 2% a year, over 50 years, there would be a 100% chance that your saline implant would leak (50 yrs x 2%= 100%).  If a saline implant leaks, it is obvious.  It's a bit like having a flat tire on your car.  The saline that leaks out is easily absorbed by the body (55-60% of the body consists of saline already!). 

 http://youtu.be/ILWdCJNSTeI (here is a discussion about silicone implants)

If you wake up with a deflated saline implant, you call us, and within a very short period of time, it is replaced and you are back to normal.  If the implant leaks due to a defect, it is replaced under a warranty.  Silicone leaks can be a bit more difficult to diagnose. Wrinkling or rippling that can be seen on the sides of the breast has a higher incidence with saline implants.  What do I mean by rippling? 

 breast implant rippling

Have you ever been to the beach or swimming pool and seen a woman lean over, and the sides of her breasts have ripples in them?  That is from the native breast tissue thinning out, and the ability to see more of the actual implant.  This problem is a little more common with saline implants but can occur with either type.  It occurs more frequently in very thin patients with low body fat and large implants. 

We will be talking about implants for the next few weeks so stay tuned.  Remember that if you are coming from out of town you can email us through the contact form and we can do a great deal of the work, getting you ready here.  You come to the office close to the day of your surgery and it saves you time.  Remember this special only lasts until April 30 so you must act now!!  Call 918-786-7780 today to reserve YOUR time!!

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

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

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

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

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

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

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

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

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

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

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

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

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

What is possible?

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

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

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

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

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

  Typical loose skin after weight loss surgery.

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

Sagging arm skin after weight loss.

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

Loss of breast volume after weight loss.

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

www.greencountrybariatrics.com

www.totalbodysurgical.net

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), thighs, 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! 

The dreaded "muffin top"

  "love handles"...not so lovely

Fatty thighs...saddle bags, inner thighs, anterior thigh, and fatty knees.

AM I A CANDIDATE?

Many people will begin to notice collections of fat post baby 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 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.

Fat abdomen

 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!

To have that discussion at no charge to you, call 918-786-7780 today!!  We can help and Cosmetic appointments are complimentary!!

Mommy Makeover.....what's that??  Well, the definition changes for different parts of the country, but here in Oklahoma it usually means a breast lift (with or without augmentation) and a tummy tuck (with or without liposuction).

As most women know, after having children, the ole body has a tendency to change a bit.  The hormones of pregnancy cause skin to stretch and in many cases, it never returns to the pre pregnancy tightness.  The connective tissue under the skin also stretches, leading to the end of that flat tummy.  We all see the movie stars that have babies and shortly after...LOOK GREAT!!  Unfortunately, most of us have to work for a living and cannot spend our days at the gym or in a spa pampering our skin and re-toning our musculature.  Even if we could do that, in many cases, our genetics make it impossible to shake the effects...in many ways, it's the luck of the draw.

To get back on point, after babies and breast feeding, the breast, which enlarged during milk production, shrinks and in many cases sags.  The nipple position that used to be perky now points in a more Southern position and can lose volume.

Here is a picture that shows the different degrees of ptosis or droop.  A or "normal" is perky, high and tight.  After children, all bets are off as to where you will end up.  My experience is that if you start off with little or no breast tissue, the post pregnancy changes are less dramatic than if you start off with a large amount of breast tissue.

Other issues can also occur with shape and in some instances breast abnormalities that have been present since birth.  As you can see in the pictures below, chest wall shape, breast size, breast development, and nipple shape can all play a roll.

With all of this in mind, we try to help you return to your pre-pregnancy state if possible.  This may or may not include implants, but what it does do is re-position the nipple and lift the breast tissue that is hanging.  Some of this tissue may get removed if it is well below the fold where the breast hangs over the chest wall.  My personal experience is that most women desire implants to increase the fullness in the upper pole of the breast.  The incisions can differ depending on how far the nipple needs to move but usually they are in the form of an anchor or "lolly pop".  The nipple is not "removed", it is rotated into its new spot conserving the nervous innervation and blood supply.  These incisions have a tendency to heal very well and after 6-12 months they turn into little white lines.  Implants, saline or silicone, are placed through the same incisions and usually under the muscle so they stay in place over time.

Now for the tummy.....   We see stretch marks, sagging skin, bad c. section scars, bulging, hernias...you name it.  The way to remedy all of these things is with the tummy tuck.

A tummy tuck is done through an incision in the lower abdomen a few centimeters above the labia.  The incision goes from hip bone to hip bone and also around the stalk of the belly button.  The skin is raised off of the underlying connective tissue and muscle up to the ribs.  Once this is done, the loose muscle and underlying connective tissue is tightened back up to make the abdomen flat.  The skin is then pulled down and the extra is removed.  A new opening for the belly button is created.  The smooth, non stretch marked skin from above the belly button is pulled down and stretch marked tissue, scars, etc. are removed.  The incisions are closed and within 6-12 months they become thin white lines.  Some can get away with a mini tummy tuck which removes a small amount of sagging skin (below the belly button) only.

Liposuction can be added to either procedure to remove problem areas in the hips, under the arms, thighs and saddle bags.

The great thing is this.....at Total Body Surgical, we can do both procedures at the same time, saving time and money.....one anesthetic, one recovery time.  How can we do this??  Because we have two fellowship trained Cosmetic Surgeons that work very well together.  We can do both procedures in under three hours and usually as an out patient.

Get your pre baby body back....come see us today!!

Call 918-786-7780 for a complimentary consultation!

We have special spring pricing to help you get back in shape for summer!

Hey everyone!!  Hope ya'll are avoiding the flu bug...bad deal!  People are dropping like flies around here.  The epidemic should be over in a couple of weeks and we'll all be feeling better.  In the mean time, drink plenty of liquids and keep the tylenol handy.

What I want to talk about today is the other epidemic we face in Oklahoma, and essentially the entire country....obesity.  As most of you know, we are in the process of becoming a center of excellence for bariatric surgery.  The new guidelines are out for review and if accepted in the current state, we should be there this year.  What that means is, we will be able to accept Medicare, Soonercare, and most other insurances.  This is good news.  Our goal is to provide quality care locally, big city care with a small town twist.  We are also committed to giving great value, the best pricing around.

We are in the process of doing seminars in multiple towns in the area.  The schedule has been set, but not finalized.  The first one was in Grove this past week and it was a great success.  They last about an hour and cover weight loss surgery, post weight loss cosmetic surgery, and a little about veins.  It's a great opportunity for us to meet you and for you to see what we are about.  It also gives you the chance to start the ball rolling to the new you.  With the lap band, or the gastric sleeve, you can expect to lose a substantial amount of weight and in doing so, correct many of the problems associated with that weight.....hypertension, type II diabetes, joint breakdown, sleep apnea, cholesterol issues, and others.  For those with insurance, we can start the process for you at the seminar (in fact, the seminar is usually a requirement).  For those without insurance, we are working up something special to give you the best price available anywhere.  This will be a limited offer so if you need help, or know someone who does, keep and eye out here...you don't want to miss it.  Of course our current lap band offer still stands and is a great one.

The communities we will be coming to soon are, Vinita, Pryor, Tallequah, Joplin, Miami, Grove, Claremore, to name a few.

We look forward to meeting you and helping you get on track.  Of course you can call for an appointment at any time....918-786-7780

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

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

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

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

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

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

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

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

“Please help me.  I’ve tried every diet out there.  I exercise.  I just can’t get rid of my weight, and it’s literally killing me.”  These are the words I hear all too often in my clinic here at Green Country Bariatrics in Grove, OK.  You see, obesity has become a problem in our United States, and it’s not going away- not even close.  In fact, recent studies of the population show obesity increasing exponentially throughout the world with the USA leading the way.  More specifically, Oklahoma is ranked 7^th, with Missouri close behind at 11^th.  It is truly a staggering statistic to consider  that 30% of our nation is now considered obese.

Why am I overweight?

What is the reason that I continue to be unable to get rid of my excess weight?  Unfortunately, this is not an easy question to answer in a simple way.  Multiple reasons and theories abound, though most likely, it is a combination of more than one of the following explanations:

1. Psychological

Certainly, overeating can be a reason why you’re overweight.  However,
let’s be honest: eating makes us feel good, right? Many eat not just because they are hungry, but rather a result of feeling lonely, bored, or depressed.

2. Anti-Depressants and Other Medications
Did you know that weight gain is a somewhat common side effect of many antidepressant medications?   By slowing down your metabolism or increasing your appetite, they make you gain weight.  Other common medications that cause weight gain in some form or another are Beta blockers and anti inflammatory steroids (corticosteroids).

3. Sleep Deprivation
Look, we all know that we are living in a busy world.   Fitiing in a normal life around work, kids, and various other responsibilities can be difficult.  Did you know that 63% of Americans feel that their night’s sleep is not meeding their daily energy needs?  Scientific studies prove that people who sleep less than eight hours a day gain more body fat that those who sleep more. Why?
Sleep deprivation causes the hormones that control our hunger to get out of control.  What else do you do during the day when you feel sluggish and tired? Yes, that’s correct. You guessed it: we grab that high calorie soft drink, candy bar, or whatever catches our eye in the vending machine to give us a “pick me up”.

4. Slow down!
Did you know that the part of our brain that helps to govern our hunger (the hypothalamus) shuts down after 25 minutes into a meal?  Slow down.  Chew your food.  You’ll find that you won’t consume quite as much.

5. How we picked our parents
Your genes may be causing you to have trouble fitting into your jeans.  According to research, metabolic rate and where your fat is deposited on your body has been linked to genetic inheritance.  Are one or more of your parents heavy? If so, you’ll have a higher risk of gaining and retaining weight.

What do I do?

Fortunately, we live in a day and age of new techniques and  technology to help those with weight issues resolve them.   Did you know that 98% of people who lose weight through diet and exercise alone eventually regain their weight? I have seen countless people at their wits end and frustrated, suddenly find hope.  There IS a light at the end of the tunnel!   Our main focus at Green Country Bariatrics is on YOU.  That being said, our way of getting there is surgery.  We specialize specifically in adjustable gastric bands (lap bands) and gastric  sleeves.  What if I told you that I could help you lose 70-80% of your excess weight?  What if I told you that I could give you a >50% chance that we could cure your diabetes and get you off of your blood pressure meds?  That’s EXACTLY what we offer at Green Country Bariatrics.

Tell me more!

Lap Band: This is a fully adjustable collar that is placed around the top of your stomach.  In a nutshell, it causes you to eat less, and makes you feel fuller, faster.  It is nonpermanent, and is usually done on an outpatient basis.  Occasionally, a patient will need to stay overnight due to their insurance mandate.  A patient will visit our clinic to tighten or loosen the band when needed. A 50% maximum excess weight loss is often seen. Return to work is usually within a week.

Gastric Sleeve: This is an operation that removes 80% of your stomach.  In doing so, we remove the part of the stomach that houses the hormones that cause you to feel hungry.  In addition, we are removing the part of the stomach where you store your food.   It should be noted that it is much safer and quicker than the traditional gastric bypass.  Many of the complications often seen with the traditional gastric bypass (ulcers, internal hernias, dumping syndrome, etc) are NOT seen with the gastric sleeve.  In addition, the anatomy is not rearranged as it is in the gastric bypass or mini gastric bypass.  However, the weight loss is very similar with both giving approximately a 70-80% excess weight loss.  All the perks, but fewer of the hassles!  It is a permanent procedure, and will require 1-2 nights in the hospital.  Return to work is often within 2 weeks.  Many insurances now cover this procedure.

Green Country Bariatrics

We are here for YOU.  We want to tailor your weightloss surgery to fit your needs and personality.  Certainly, we here at Green Country Bariatrics understand your challenges with weight, and want to provide whatever support we can in order to help you accomplish these goals.  Please note that in treating our patients, we want to see you reach your maximum weightloss potential and keep it off!  In doing so, we help you get started with our nutritionist to teach you how to eat, and make better food choices.  We also encourage participation in a support group for camaraderie, accountability, and just being around others who have been through the process.  A contact with a trainer in your area for post surgical exercise can also be arranged.  Lastly, in beginning the new you, many of our patients desire to have reconstructive surgery to lift and remove excess skin after the wight has been lost.  This is completely optional, but we find that the majority of our patients opt for this to complete the transformation process. All of our surgeons at Green Country Bariatrics are fellowship trained in this particular type of reconstructive surgery.