Total Body Surgical Blog

                                                                                      Let's talk about eyelids for a bit.  As the old Yiddish proberb says, "the eyes are the mirror of the soul"....eyes are very important.  When we meet someone, where is the first place most people look??? the eyes.  Therefore, if we have prematurely aging eyes, they can make us look older, more tired, and cover one of the most beautiful attributes we all have.  Eyelids, though small, can change even the way we think about ourselves.  We look in the mirror and even though we don't feel tired because of the "tiredness" we see in our eyes we begin to reflect it in our actions.

Youthful eyes are wide and inviting.  The upper lid is full with few wrinkles and no excess skin present.  The lower lids are smooth with skin color that is pink.  There are no bulges, folds, or "bags" to draw our attention from the color of the iris or the pupil.  We see well as there is no abstructing skin in the way.  We look and feel great.

As the instoppable aging proces happens, eyes, are at times, the first thing to reflect it.

  Why is this?  When did it happen?  How did the first picture become the second??  Well, let's get some answers.  The eyelid skin is some of the thinnest skin on the body.  It also moves more than the other skin and it is constantly exposed to the damaging UV rays of the sun.  The other thing that happens is a loss of fatty tissue in the face.  This exposes underlying connective tissue where it is tethered to bone.  Lines and bulges that are normally window shaded by ample fat pads begin showing up when those fat pads diminish.  Fine lines and wrinkles develope from sun damaged skin, motion, and sagging of the muscle around the eye.  The process is unrelenting and over time, the sagging skin can even decrease vision.

  What we see here is a large amount of extra skin on the upper lid obstructing vision and the fat pad below the eye is protruding with severe skin changes.  Regardless of actual age, these changes can create the image of a very old person and the view of the eye is just a slit...not a very good view of the soul.

At Total body surgical we do a lot of eye rejuvenation.  It is one of the more rejuvenating procedures we do.  It is fairly simple and can take years off.  Upper lids are done with some light sedation and local anesthesia.  Lower lids can also be done with light sedation sculpturing the fat pad and either removing the loose skin or lasering it to tighten it up.  We often graft fat into the cheek to restore a more youthful look.  Recovery time for upper lids alone is quick, usually about a week and for lower lids a week or two depending on laser use.  We have great pricing on lids so be sure to check us out!  Cosmetic consultations are complimentary so call 918-786-7780 for a visit.  Also remember our other offers on the lap band, breast augmentation, hair removal, and liposuction.  Summer is right around the corner, so get ready now!!!

Now is the time!!!  Time for what you ask??  Time to get a jump on summer!

There is a lot that can be done to get ready for a new look this summer.  Probably the biggest thing (no pun intended) is a breast augmentation.  Many women think about doing this when summer is already here.  Then, it is too late in many cases to enjoy them.  It does take a few weeks to recover and regain normal activity.  So in reality, now is the time.  Do it in the winter, recover in the winter, and unveil in the spring and summer.  Spending time at the pool or lake in your new suit with new assets will be great fun for you after an augmentation. 

Whether you want saline implants or silicone gel implants, we, at Total Body Surgical can take care of your needs.  We are here to please.  I will personally listen to your desires, we will discuss the pros and cons of different implants, placement options, and especially sizes.  Most women are worried that I will choose the size and you will be stuck with it.  At our facility I will give you a range of sizes based on your measurements and we will try them on in your clothes and YOU decide so you can get the look you want.  Our special pricing for this summer is $3899.00 for saline implants and $5099.00 for silicone implants.  This includes all fees with the exception of medications that you will get from the pharmacy.  It includes the pre op and all post op care. 

The other big thing we have discussed recently that can make a huge difference is liposuction.  Many women have small areas (hips, thighs, saddle bags) that are unsightly.  These areas are difficult to get rid of even is you are in great shape and exercise regularly.  This is when liposuction shines!  For small areas we can do them in the office with or without sedation and it is very affordable.  Recovery time for a single small area is very short (a weekend or so) and when using the laser the skin contracts well over the next few weeks and looks great.

Our pricing for liposuction is fantastic and we have bookings available now.  As summer approaches, spring break, etc. get closer, the operating times get tight. 

Come now and get these special prices and book your time before it is gone!!

Don't forget our amazing hair removal offer as well!  Just $50. per treatment (an average of $300 per area).

"Hairless summer".....do you want one??  No shaving, no creams, no embarrassing moments at the pool or beach, no rashes.....NO problem!

Most women (and men) have hair they don't want.  It is a constant issue we all deal with.  With summer approaching, NOW is the time to start the process of hair removal.  How would you like to wake up and not worry about underarm hair, leg hair, bikini hair, back hair or any hair in a place you have to groom over and over again.  I want to assure you that we, at Total Body Surgical, have the best and latest technology to reduce hair in all areas at prices never before seen in the region.  

We have talked about hair removal and how it works in the past but a review is in order.  Laser hair removal has been around for some time and is very effective when in the right hands.  It works by killing the hair stem cells that create the hair from the follicle.  This image shows how the dark hair absorbs the laser energy and carries it to the hair creating cells in the follicle and eliminates them.  Through this process, the hair becomes thinner, lighter, and in most cases, is eliminated all together.  We can treat hair anywhere on the body with excellent success.  In most cases it requires an average of 6 treatments for body hair and 9 treatments for facial hair.  The treatments are usually spaced about 4-6 weeks apart to allow the hair to be treated in its different stages of growth.  Due to new hair follicle development during life, some people may require "touch up" treatments in the future, maybe a couple of times every few years.  Laser technologies do not work well on blond, white, or gray hair.

At Total Body Surgical we have the latest IPL and Laser hair removal technology.  Using the Cutera 1064 YAG laser and the Pro Wave 770 IPL we can treat most areas quickly and with minimal discomfort. 

Why are we different than all the other places??  In the past, laser hair removal was very expensive.  The technology is not what most would call cheap.  This equipment can cost several hundreds of thousands of dollars and treatments for larger areas can cost thousands.  At Total Body Surgical we realize that removing unwanted hair applies to all of us and not only the wealthy.  Therefore, we have concentrated on reducing our prices to rock bottom.  We are offering hair removal for $50.00 per treatment per area.  This means that you can have hair removed from an area...let's say underarms....that's an average of $300 for 6 treatments.  Bikini area.....$300.  Both areas.....$600.  This is an outstanding deal that is not a special, it is our usual pricing and it's hundreds less than most providers.  It is worth the trip to Grove and the lake to have this done and can be life changing in time savings and removing the stress of unwanted hair growth.

Come see us soon, and don't forget our other special prices!!!

New blogs starting after the new year.

Let's hope 2012 will be a great one and that things actually do "change".

Look for some of the same offers this year AND some new ones.

Thank you all for making our year a very good start here in Grove.

Last week we discussed more common general surgery procedures that can be performed with Cosmetic procedures.  What else can be done???  It is hard to come up with a complete list there are so many. 

Here are some suggestions:

Many people have a fear of needles.  While anesthesia is administered for other elective surgery, it is a great time to place dermal fillers in the nasolabial folds, marrionette lines, or even augment the lips.  Of course Botox can be injected as well.

More substantial procedures can be done as well.  Breast augmentation can be added to elective laparoscopic procedures such as laparoscopic cholecystectomy, small laparoscopic hernia repairs, many gyn procedures and so on.  Of course if the primary procedure is being done due to infection or obstruction or other serious illness, this is not possible.

Laser skin resurfacing can be done while under general anesthesia for non-emergent procedures as well.  This allows the procedure to be done without the discomfort sometimes associated with resurfacing.  Light therapy for sun spots or closure of facial veins can also be done.

Arm reductions, small area liposuction, face work, injections, laser work, tummy tucks, breast augmentation can all be added to general surgical procedures when the procedure is purely elective. 

What are the advantages of combining procedures??  As we discussed last week, the advantages are many.  First of all, a single anesthesia is very advantageous, lowering risk by limiting the number of anesthetic exposures.  Secondly, a single surgical recovery is much better than multiple ones.  The recovery is simultaneous.

There it is, short and sweet.  Procedures can be combined if desired and safe.  Come see us at Total Body Surgical and we can discuss what is possible.  Call 918-786-7780 or fill out a contact form and we will call you!  Don't forget our special pricing on liposuction, lap bands, nail fungus, and fillers.

We are also planning Botox events in Grove and in Tulsa this month to be ready for the holidays.  Special pricing will be offered at these events.  Sign up using a contact form and we will inform you of the dates and times....or you can call.

More next week!  Oh, and like us on facebook!

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

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

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

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

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

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

One of the most common fillers is Juvederm.

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

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

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

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

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

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

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

Watch this video for a little laugh....

http://youtu.be/nB7wtLMsm5c

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

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

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

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

Here are the facts:

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

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

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

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

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

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

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

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

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

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

Do I need a lift?? Todays blog is in response to a question I was asked on Facebook.  This is a question I hear almost daily.  It's a question many women are scared to ask.  The four most common cosmetic breast procedures are:

1.  Augmentation.

2.  Breast reduction.

3.  Breast lift.

4.  Breast lift with Augmentation.

So how do you decide what you need??  First, reduction.  Breast reductions are done cosmetically for women who have breasts that are too large for their frame.  They are so big that they interfere with life in general.  Clothing doesn't fit, bras are difficult to find, they can be embarassing.  They become a medical issue when neck pain, back pain, rashes, strap marks, etc. start to occur.  This is when insurances start to kick in and may cover the procedure.  They usually require certain criteria to be met and a certain volume must be removed for them to pay.  A reduction is done to reduce volume and make the breast smaller.  A lift is done to reposition the nipple.

Lift vs. augmentation vs. lift and augmentation.

The choice of procedure is at times a judgement call and also depends on what the patient is looking for.  It all depends on the position of the nipple relative to the infra-mammary fold. (the fold below the breast where the breast stops and the chest wall begins)  If the nipple is well below this fold then a lift will usually be necessary.  If this breast is augmented, the nipple will still hang and the "Snoopy Nose" breast occurs, nice implant with a drooping breast over it.  The nipple must be raised and centered either in the breast or placed where it will be in the center of the implant.  If the nipple is above the infra-mammary fold then usually only an augmentation is done.  When the nipple is at the fold is when good judgement and figuring out what the patient is after, managing expectations, and all the other unmeasureables come into play.  For a lift, you will have scars.  They usually heal very well and after a little time are fairly inconspicuous, but they are there.(nipple above the fold-augmentation)

If a lift alone is done, the upper pole of the breast has a slope to it and may lack fullness.  Many women don't like that look and for them, an implant gives the breast a fullness that recreates the youthfull breast.

Notice the lateral view where the upper pole is sloped after a lift/reduction only.

Notice the fullness in the upper pole after a lift and augmentation.

I hope this helps clear some things up about what procedure is right for you if one is desired.  If you have a question, facebook me and I will address it.  Next week I will discuss liposuction.  Don't forget to check out our specials!!

Sorry everyone!! An Internet crash at the Grove address forced me to delay writing this installment.  The double edged sword of modern technology. 

This week I want to discuss removing the large varicose veins.  This was once done with larger incisions that left unsightly scarring.  We now perform what is called the European Micro phlebectomy.  What that means is that the veins are removed using a technique developed in Europe.  The difference is that this technique leaves very little scarring and is much more Cosmetically appealing than the old way.

The large varicosities that we see in the leg is usually not the actual disease.  As discussed in previous blogs, this disease is from incompetent valves in the saphenous system in most cases.  These big and ropey veins develope in response to the increased pressure in veins deeper in the leg.  Once closed with the laser, the deeper veins no longer feed these enlarged "branches" or varicosities.  When this happens a number of problems can occur, they can become painful, they can clot and cause phlebitis, they can cause skin color changes.  These problems will usually resolve with time but can be miserable. 

How is the procedure done??  After closing the system that is feeding the visible varicose vein, the large ropey veins are marked with a marker with the patient standing.  Local anesthesia is injected into the areas to be removed and in our office, IV sedation is given.  Once the local has taken effect, very small incisions are made and small instruments are used to grab the vein, elevate it, and tease it out from under the skin.  It is completely removed if possible.  The incisions are no more than a couple of millimeters in size (less than an eighth of an inch).  No stitches are placed, and a compression dressing is applied with Coban to hold pressure.  Some minor bruising may occur that lasts for a few days, the wounds may leak minimally for about 24 hr or so.  We have patients walk out of the office and most experience very little discomfort after.  The wounds heal very well and usually go unnoticed after 6 months or so.  Once removed, the painful and ugly source of embarassment is gone.

Next week....Cosmetic sclerotherapy and how to get rid of spider veins.

Call Total Body Surgical today for YOUR vein evaluation 918-786-7780!

Since there have been no requests about special interests, I get to choose!!  The next few weeks I will address veins and what to do about them.

The reason Cosmetic Surgery and Vein Surgery are so intimately associated is quite simple.  I can liposuction, augment, and tuck everything to make the body look great, and yet, if your legs look like this.....

it makes it hard to wear a dress, shorts, a swimming suit, or any other attire. 

Vein disease or chronic venous insufficiency, is a common problem.  It is thought to effect at least half of the population to varying degrees.  It is thought that the problem is hereditary, but can have other causes such as trauma or thrombosis (clotting).  The veins causing the problem have valves in them that no longer work properly.  The muscles of the lower leg act as a pump to move blood up the veins as they contract.  The valves are supposed to allow the blood to travel towards the heart but not let it return down the leg.This picture illustrates normal valve activity.The second image shows a comparison of normal with abnormal function.  When these valves are defective, the blood is allowed to return down the leg, increasing pressure and causing tributaries to dilate and become tortuous.  Spider veins also develope as the pressure causes enlargement of smaller veins in the skin.  The disease is not limited to appearance either.  This process causes cramping, restless leg syndrome, skin discoloration, rashes, ulceration with secondary infection, swelling, and ultimately, disability. 

The reason that these problems happen is multifactorial.  Pressure, low oxygen tension in venous blood, and the leaching of iron products from the hemoglobin in the blood and into the skin.  Depending on the severity of the reflux these symptoms may occur early or late in life.  

I hope this discussion helps shed light on why venous problems develope.  Over the next few weeks we will dive into the diagnosis and treatment of chronic venous disease.