Total Body Surgical Blog

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

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

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

Another area commonly complained about is the Marrionette line area.

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

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

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

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

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

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

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

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

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

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

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

Let's talk about a common problem that we can help with.....acne.  Acne vulgaris is a common problem in adolescence that can continue or leave long lasting changes through adulthood.  It most commonly occurs on the face and back but can cause problems almost anywhere.  It occurs in these places most commonly because of glands that produce a large amount of oily material.  The pores become "plugged" with this thick, oily material and bacteria (germs) get in the mix causing inflammation and pimples.  It occurs when hormonal levels are peaking, thus the high rate during adolescence but adult acne is also a common problem. 
Certainly, acne is not a life threatening condition but it can ruin self esteem and lead to life changing and permanent skin damage.  It can cause scarring and pitting of the skin that will carry through life in severe cases.  Many of us have mild and sporadic breakouts that are only a minor problem, but for some, acne is a curse that can ruin social interactions and make us very self conscious.

At Total Body Surgical we take a systematic approach to the treatment of acne.  I like to evaluate at the initial visit how severe the problem is and what potential for permanent skin damage there is.  If the problem is not severe, we start with a good skin cleanser that contains salicylic acid to remove the oil the skin is producing.  I like the clarifying cleanser made by Skinceuticals.  We also like benzoyle peroxide products for a topical kill of bacteria. Retinol or tretinoin is also used topically to help the skin turn over quicker.  This is usually our first line of treatment for even the worst cases.  For more severe problems I will add a topical antibiotic gel or start treatment with an oral antibiotic at low doses to decrease the inflammation and lower the bacteria count.  These steps will usually make the condition improve a great deal, at least enough to make it tolerable.  If not, the next step we use is the Cutera 1064 laser.  The laser genesis treatment is painless and quick with no down time.  We use the laser to gently warm the skin to a temperature  that eliminates the bacteria causing the problem.  This is usually very effective and allows the other treatments to take hold.  It is also a good way to get ready for special events...treat a week or so before and have a clear face!!  These treatments can be done at 4-6 week intervals and are very affordable.

Now for the severe cases...the dreaded Accutane!!!  I am very careful when I choose patients to use this medication.  They must be reliable and have good supervision from a parent.  The i-pledge program must be followed as well which gives good counseling about pregnancy prevention while on the medicine.  Accutane IS a great drug...it works almost universally.  It can, however, have some severe side effects that are not very common (regardless of what the lawyers on TV portray).  It can cause depression leading to suicidal thoughts, headaches that can be severe, birth defects if you become pregnant or make someone pregnant while on the drug, very dry lips and skin, dry eye....and the list goes on.  Most treatment regimens start at full dose and after clearance of the acne we switch to a lower dose program which seems to be effective.  Any of the above problems that become severe may require a stoppage of the medicine. 

I have found that most individuals will require a minimum of 6 months of Accutane and some may need more than one course of the medicine.

For those with permanent acne scarring we offer the Pearl laser.  You must be off of Accutane for a minimum of 6 months to qualify but these resurfacing treatments help tremendously to soften the scarring.  Down time is around 4-5 days and treatments can be repeated to desired effect.

If you need help with acne...give us a call at 918-786-7780...we'll be glad to give you the help you need.  Don't forget our laser hair removal...$50/treatment/area special too!!

Many questions exist about liposuction.  Most people have an image of a very violent and bloody procedure with results that are less than optimal.  Todays liposuction is much different.  Due to techniques we use today, liposuction can be done in the office, with only sedation.  I would like to address a number of questions that are commonly asked of me during a consult, and many points that I like to talk about with patients to help them understand what they are to expect. 

First, will I get fat in other areas after liposuction?  This is one of the more common questions I am asked.  The theory is that we are all born with a finite number of fat cells.  As we gain or lose weight, we do not gain or lose these cells, they just grow or shrink in size.  Some data show that in the super obese, cell numbers may actually increase but we don't liposuction these people.  During liposuction, we remove fat cells in the area we are treating.  Therefore, if someone gains weight after liposuction, it will accumulate in other areas since we have removed the fat cells in the area they have gained in before.  This is true, however, to make a significant difference, it has to be a significant amount of weight....20-30 lb.  Most people that spend the money on this type of procedure are not going to let this happen.

Second, will I get lumpy in the area of liposuction?  This can happen, especially after weight gain.  If you think about the procedure, we are removing layers of fat...not all of the fat.  Some remains.  This is a good thing.  Leaving a layer of fat below the skin allows the skin to remain smooth and supple.  Oversuction can create dents and allow the skin to scar to connective tissue underneath....both bad things.  With some live fat remaining, if you gain weight, these pockets of fat cells will increase in size and can form areas of lumpiness.  Lumps in the immediate period after liposuction are a normal thing.  Usually they are a little sore and represent areas where fat has been damaged and the body is breaking them down.  I like for people to massage these areas to speed up the process.  It can take several weeks to months for them to completely resolve.

Third, will my skin be saggy after the procedure.  This is the thing that is hardest to predict.  The things I look for are the ones that indicate skin quality before the procedure.  For example:  The stretch marks in this photo would indicate to me that a tummy tuck would be a better choice for her...why?  Her skin will have less of a chance of contracting after the fat is removed because of the poor starting skin quality.  It will be more likely than not that her skin will not contract.  This does not rule out liposuction for her but she must understand that, in clothes, she will look better and more sculpted, but in a swimming suit, the skin will still look bad and possibly more saggy.  If her skin were smooth, she would be a much better candidate.

Fourth, will the newer technologies help the final result?  Yes and no is the answer.  Laser and ultrasound technology have helped but they are not the silver bullet.  I like to use them as an adjunct to traditional liposuction.  The idea is that heating the skin from the inside does cause some contraction, how much is the unknown.  I remove the fat first then use the laser to heat the skin to allow skin contraction.  Several studies have been done that indicate the use of these technologies alone are sub-optimal and my experience verifies this.

We do liposuction often and combine it with many procedures.  It is a great procedure and helps a lot of people.  We do the procedure in the office with sedation and tumescent solution.  This solution contains lidocaine that numbs the area and also epinephrine that causes the small blood vessels to contract and limits blood loss.  Patients recover quickly and this depends on the size of the treatment area.  It takes the skin several months to contract and heal so the final result is seen after 3-4 months.

Come see us for a consult and for a limited time receive 10% off of the procedure.  Don't forget our laser and breast offers too!!!!

918-786-7780

Breast disease for men???  What the heck you say.  Well, it does happen even though breast problems and Cosmetic breast surgery IS much more common for women. What kind of problems would a guy have is a question you might ask.  Well, there are several, but today I want to address a problem called gynecomastia.  Gynecomastia is a word that means puffy nipples.  Gynecomastia normally occurs during hormonal changes in the life of infants, adolescents, and men.  The first time in life it occurs is in infancy.  After birth, estrogen from the mother is high in the infant and breast tissue develops that rapidly disappears.  It also occurs in elderly males as the hormonal changes of aging take hold.  Many medications can also cause the breast tissue to increase.  Other causes are beyond the scope of this installment.  I mostly want to focus on the adolescent occurrence.  In adolescent males, gynecomastia can develop in as high as 80% of individuals.  Again, its the hormones that occur normally and in those who use anabolic steroids.  Unfortunately, in up to 30%, it doesn't go away this time.  Gynecomastia during adolescence is made of fatty tissue with a bud of breast tissue under the nipple.  By the early 20's it should be gone, if not, it may become a real problem.  The problems it causes are not generally physical but psychological.  Wearing normal clothing becomes an uncomfortable situation for a guy that has breast tissue and makes one very self conscious.  Working out to develop pectoral muscles can often times only make things worse...so what's a guy to do??  First of all, be patient.  It is hard to do but fortunately, in a majority of cases the problem resolves after hormone changes settle down.  In cases that don't resolve, we can take care of the problem.  Usually, in the normal case, I will liposuction the chest and remove the "bud" of breast tissue.  I do this through a small incision in the arm pit to liposuction the chest of excess fatty tissue.  I then make an incision through the nipple to remove the small bud of breast tissue.  We do this in the office procedure room using some IV sedation and tumescent local.  It takes less than an hour and can be life changing.  We have you wear a compression shirt for about 3 weeks and from that point on, normal clothes can be worn without the worry of those two little reminders poking through.  The incisions heal very well and go unnoticed after a healing time of a few months.

If you or someone you know has this problem, come see us!  We can help.  Call 918-786-7780 for an appointment.  Don't forget our other specials as well...laser hair removal, breast augmentation, nail fungus eradication, and great pricing on Obagi skin care products.

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

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

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

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

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I guess the test last week was not so good judging from the response.  A few people really loved it so I may consider doing another in a few months....maybe on breasts...lift vs augmentation alone....or....faces, mini vs. full face lift....we'll see.

Today I want to discuss the Pearl laser.  Lasers have come a long way in the past 10 years.  We have gone from a technology looking for a procedure to actually being able to make a huge difference in a number of skin issues.  The great thing is that recovery times and safety have jumped in leaps and bounds. 

There are many reasons to choose laser skin resurfacing.  What resurfacing can do is:

1.  Reduce facial skin discolorations such as brown "age spots" and other discolorations.  These are caused by sun damage and age.

2.  Reduce fine lines and wrinkles in the face, neck, under the eyes, and crows feet.

3.  Shrink pores that are enlarged.

4.  Improve acne scarring.

5.  Improve skin color and texture.

6.  Improve vertical lip lines.

Why the Pearl??  The Pearl laser is fairly new technology that is similar to the CO2 laser.  What makes it good?  There are a number of reasons the pearl is superior.  First is recovery time.  The recovery time from the average treatment is only about 4 days.  This means that new skin reforms quickly, much quicker than the CO2.  Second is cost.  The cost of the Pearl treatment is $1200.  Compared to the CO2 this is less than half.  Third, you don't need general anesthesia.  We usually do the procedure with some mild oral sedation and topical anesthesia. 

The Pearl is made by Cutera..hit this link for more technical information.  Here is also a video from The Doctors that talks more about it.

www.youtube.com/watch?v=8OBi5AcQwWQ

Come see us and you won't be sorry....your youthful skin awaits.

What is IPL?  It is a great way to remove unwanted discoloration or dyschromias on the face, chest, hands...anywhere on the body.  It is the use of Intense Pulsed Light or a flash lamp to influence the pigment cells in the skin. 

How it works is by using a specific wave length of light that targets certain color in the skin.  The color we usually are after is brown.  Age spots, liver spots, whatever you want to call them, are a problem caused by skin aging and sun damage.  They are present on sun exposed parts of the body.  The IPL is absorbed by these brown areas that then peel off and are gone.  The melanocyte (the pigment cells in the skin) is encouraged to turn off and when the skin is then protected from future sun exposure, they usually stay away.

  (melasma or brown spots from the sun)

We like to combine good quality skin care with Obagi products to speed up the effects of IPL and make them longer lasting.  The Tretinoin and hydroquinone causes the skin to grow faster and the hydroquinone turns the melanocyte off.  The IPL gets rid of the current brown spots and voila your skin begins to look like it did before the sun and baby oil did its damage!!!

Red spots on the skin can be caused from sun damage as well.  Also causing the problem are small blood vessels in the skin.  To treat these areas the wave length is different but the process is the same.  The small blood vessels are injured by the light, closed, and the vessels are broken down by the healing process.  The red areas are removed.

Usually, IPL treatments are done in a series of 3-5 treatments.  Once problem areas are gone, protection from the sun is the key to long term success.  

A treatment consists of about a 20-30 minute application of a numbing compound.  We wash that off and the actual treatment takes only a few minutes.  Hands can be treated as well and most want the decollatage or chest area treated too. 

We use the Cutera XEO system which allows us to use multiple wave lengths or combine wave lengths in a single treatment.  At Total Body Surgical we charge $150 per treatment and we have special pricing for packages of multiple treatments which is usually required.

Don't forget our breast augmentation specials on silicone and saline AND we are having great success treating nail fungus with the laser.  Our lunch time lipo special is still running also and our laser hair removal at $50.00/treatment/area can't be beat!  We have people driving from Memphis, Tn because we are so cheap!!

Call today for a consultation..918-786-7780.

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

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

http://youtu.be/kceaEMmi7pA

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

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

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

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

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

Talk next week!!

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

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

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

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

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

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