Total Body Surgical Blog

For the last installment on massive weight loss, we will look at the face. Massive weight gain can cause unrecognizable changes in the face.  The neck, cheeks, and chin become stretched with fatty deposits and cause skin changes that may be permanent even after weight loss.

For the lucky few, facial skin will shrink back to its near normal state.  In these cases, nothing is needed.  For the most part, however, what we see is skin that sags in the neck area and jowl formation in the lower face.  Wrinkles may also appear in the cheek area and in the mid face we see volume loss that creates that "tired" look.  In people that lose massive amounts of weight, these changes can occur regardless of age.  When weight loss patients present, they usually have numerous areas of concern and I try to help them prioritize because we cannot do all procedures at once.  Some want their face fixed first, some don't, again, it is a matter of priority.

The only way to gain long term results in recovering a youthful face are lifting procedures.  We devide the face into three main areas. 1. The lower face and neck. 2. The mid face. 3. The brow.  A fourth area would be the eyelid that I will talk about in a later blog.  

The lower face and neck lift.  This procedure addresses the excess neck skin, jowling, and wrinkling in the cheek area.  Sagging skin in these areas can be very pronounced after massive weight loss.  Incisions for this procedure are placed around the ear   and a small incision under the chin.  The arrows show the direction of pull on the skin and the underlying muscle.  If the neck is not lax, a mini face lift (s-lift, lifestyle lift, day lift, etc.) can be done which shortens the incision to the front of the ear and only partially up the back of the ear.

The brow, when sagging, can cause visual problems and most notably can cause wrinkling in the forehead because of continuous muscle contraction as your brain lifts the brow.  For the most part, I use the endoscopic approach to lifting the brow.  This is done through small incisions in the hair that are essentially invisible.  The brow is lifted and anchored.  After doing this procedure, the forehead becomes smooth and the hooding over the eye is gone.

The face lift and brow lift can be done simultaneously if desired.

For the mid face, the problem is usually loss of volume and a hollow appearance develops.  I feel the best way to remedy this problem is by replacing this volume.  This can be done in several ways.  The shortest lasting way to do this is with a filler product.  The volume is placed over the cheek area.  The second best product is fat.  The fat is harvested from the hip or abdominal area and transplanted back into the face rejuvenating the mid face.  The longest lasting way is with implants.  These are solid silicone, pre-formed devices that replace the lost volume in the area.

These three procedures are the ones most commonly used to treat and rejuvenate the face after weight loss.  Not everyone fits the usual mode however, and consultation to figure out the best treatment for you is essential.  Come see us at INTEGRIS Total Body Surgical for a complimentary cosmetic consultation.

Don't forget our breast and lap band specials that are still going on. Act now to take advantage of great savings!! 

To continue the conversation about body contouring after weight loss surgery, this installment will address the thighs and knees.  After the weight loss, the tummy tuck, the arm reduction, the breast lift, and the butt lift, many people are ready to address the thighs.  You may not need all of these procedures, you may only need one or two.  If more than one procedure is required, I usually save the thighs for last.  Why??  Well, to be honest, it is a difficult recovery because of where the incisions must be placed.  Do you need a thigh lift, or will liposuction cure the problem?  It depends on the amount of extra skin that is present.  Too much sagging skin will not contract with liposuction and will need to be removed.  A problem area of fat depostion can be liposuctioned. 

Incisions for a thigh lift are in the groin, following the contour of the upper thigh.  To lift the knee, the incision travels down the inner thigh, making a kind of "T".  Removing this skin allows us to make the thigh tighter and removing the skin in the groin allows us to pull the skin up getting rid of the sagging and re-shaping the thighs.  The incisions are placed in a high motion area that stays moist and is close to areas that can be difficult to keep clean.  These factors can make wound healing a challenge in the best of circumstances.....thigh lifts are not for the faint of heart.  They can, however, make a huge difference in appearance and wardrobe. 

Come see us at Total Body Surgical for all of your body contouring needs.  Time is running out to take advantage of the Breast and lap band specials so don't miss them!!

More next week.

What about butts after massive weight loss?? 

Many changes occur after weight loss.  We have been discussing arms, abdomen, breast and when to proceed with these procedures after weight loss or weight loss surgery. 

The problem with massive weight loss is that protein stores in the body are consumed after sugar and before fat.  We all want to lose the fat first but this is not generally what happens.  Fat is the bodies way of long term energy storage and is mobilized only after other sources are used up or low.  In massive weight loss, especially after bypass surgery, muscle protein is mobilized as the weight loss proceeds.  One of the biggest muscles in our bodies is the muscles in the butt.....the gluteal muscles.  Think about it....these muscles are the lever that allow us to stand, walk, use stairs, etc., it is not just a seat pad!!  As weight loss proceeds, this muscle gets smaller as protein is mobilized and used for energy.  As this occurs, of course, the skin sags and the butt ends up on the upper thighs.  Many people want their butt back to its original position.  The way we put it back is with the butt lift.  It is similar to a tummy tuck for the rear end.  The incision is placed along the upper Gluteal region and the skin is lifted up to remove the excess.  In some instances an implant can also be placed to give more volume to the butt.  The one pictured here has had a previous tummy tuck as well.

Come see us at Total Body Surgical for all of your after bariatric surgery needs.  Also, don't forget our breast augmentation and Lap Band special pricing....time is running out so ACT NOW!!

I will continue to discuss procedures that are common after weight loss surgery.  The most common is the tummy tuck which was discussed in previous blogs and breasts are probably the second most common area addressed in women. 

The reason breast take such a beating after significant weight loss is that breasts are about 80% fat to begin with.  It follows that when women lose a large amount of weight, what is lost is fat and muscle.  The skin of the breast is "deflated" and what actual breast tissue remains hangs in the deflated skin....Rocks in Socks.

The objective when reconstructing the breast is to reposition the nipple and areola and if desired, refill the breast envelope.  There are options when rebuilding the breast.  One option is to lift the nipple and remove excess skin only.  This choice is certainly acceptable but does not give the fullness in the upper breast many want.  To get this, an implant must be used.  The incisions for reconstruction of this type vary based on the distance the nipple must be moved above the lower fold of the breast.  Usually the incision is an anchor type incision, around the nipple, a vertical and a horizontal incision below.  The nipple is not removed, just moved on a pedicle into its new position.  Breast skin and tissue is removed to reshape the breast.  An implant adds fullness to the upper aspect of the breast.  The implant can be placed at the same time.

Come see us at Total Body Surgical and take advantage of the specials above!!

Over the past few weeks (with the exception of Butts last week) we have been talking about weight loss and surgical options.  This week I would like to start the discussion on what to do AFTER losing all the weight.  I guess the first question is....who qualifies to have post bariatric body contouring??  Well, first of all, you must be healthy enough for elective surgery.  This means that your medical conditions, if you have any, should be well controlled. I think it is a fairly well known fact that most insurances will not pay for this type of surgery so I wouldn't expect it.

Hypertension, diabetes, heart disease, renal and others should be stable.  Fortunately, after massive weight loss, many of these problems are cured as the weight falls off.  The second thing that cosmetic surgeons consider is the stability of the patients weight.  My rule of thumb is a stable weight for a minimum of 12 months.  In other words, after weight loss surgery, we usually don't perform any body contouring until the weight loss has stopped and a stable weight has been maintained for a year.  This helps us avoid performing surgery more than once or getting results that are less than expected.  Since most patients are spending their hard earned money for these procedures, this precaution is usually appreciated.  One problem that weight loss patients struggle with is their new body image.  Once the weight starts to fall, the skin, which has been hopelessly stretched, does not return to its normal position and begins to hang.  As this occurs, patients have a tendency to become impatient with the process and want it removed.  It is my job to encourage patience with the process and wait until the weight has stabilized.

The next step is planning.  I like to start with a wish list....what bothers you about your new body sort of thing.  Depending on the amount of weight lost, this can be a very long list.  It also depends on how an individual loses weight.  This can be different for each person.  This is why there is no cook book remedy for everyone and procedures are personalized. 

The procedures that are requested are numerous and will be discussed in coming weeks.  Next week we will start with the most common procedure, the tummy tuck or abdominoplasty.

Last week I began the discussion on surgical options for obesity.  This week, the topic will remain the same but more In depth.

First, however, I would like to tell you about the AACS approved conference I just attended in California.  The conference was held in the Sacramento area and covered Liposuction, Tummy Tucks,                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Butt implants and Augmentation with fat.  I gave lectures on difficult tummy tucks and combining tummy tuck with other surgery.  I also gave a lecture on how to avoid blood clots that can sometimes occur around the time of surgery and lastly I lectured on advanced liposuction techniques.  The course was a roaring success and afterward we all spent the day in Napa Valley trying out some California wines.   The course was attended by physicians from as far away as Viet Nam….pretty cool.  I always learn good stuff at courses too, even if there in a teaching mode and this time was no different.  I learned some new and cool ways to shape butts and make them larger with both fat and implants or both.  I have had a fair amount of experience with these techniques but I learned some new tricks.  Now is the time to hit me up if you need a rear end overhaul!!

Now, back to obesity surgery. 

If you look at statistics for all types of obesity procedures, you will find some interesting facts.  Most of these studies look at the percentage of excess body weight (EBW) lost over a set period of time.  The way EBW is measured is by subtracting maximum weight from Ideal body weight.  This gives us a number that can be measured and compared.  If you compare bypass, sleeve, and lap band procedures, in the short term time frame, the bypass and sleeve appear to work better than the band.  However, even though most people would like to lose their weight quickly, they also know that this may not be the best for them.  The lap band is slower and requires adjustment, not because it loses volume, but because the anatomy changes as we lose weight and the band loosens.  With the bypasses, no adjustments are necessary.  The interesting thing is that the studies looking at EBW at the five year and older mark are nearly the same!  There is only a 2% difference between the lap band and the more invasive procedures when losing weight.  In other words, if you are overweight by 100 pounds and we look at your progress at 5 years, if you have had a bypass you will have lost 58 lbs on average or about 58%.  If you have had a Lap Band, you would have lost on average 56 lbs, you would have just lost it a little slower.  Pretty interesting!!  Many people have knocked the band in the past for not being as successful.  After looking at these numbers, the only difference is 2% at five years, AND your anatomy has not been permanently changed, AND it can be removed if you want it gone, AND your problems with vitamin deficiency, muscle and other protein wasting will not be as severe.  What I am not saying is the lap band is for everyone as clearly it is not.  At Total Body Surgical Cosmetic Surgery, I like use fairly clear parameters for those I think it is best for.  I think it works better when the person has a BMI between 30 and 50, has few or no comorbid conditions.  Larger patients are generally sicker from their weight and need to lose it faster.  With the lap band, you will need supervision, you will need weigh in’s and volume added to the band to help you lose the weight.  You will change your personal dynamic with food. Below is a youtube showing how the procedure is done.

http://youtu.be/KPuThbFMxGg

More next week....

Remember the breast special, the laser hair removal, and vein specials we currently have going!!

http://www.totalbodysurgical.net/breast-aumentationact-now/Default.aspx?utm_campaign=Grand-on-GRAND&utm_source

-LOVE YOUR LEGS......AGAIN!!!!

-Laser HAIR Reduction....buy one area and get one F

At INTEGRIS Total Body Surgical Cosmetic Surgery we are a dedicated Lap Band facility.  This means that we have chosen to only offer the lap band for our patients who have failed diets and are at risk for developing complications of obesity.

Obesity in America is at epidemic proportions.  Look at this from the CDC

Literally every state has an issue with people being over weight and in many states.....severely.  All we need do is walk down the street to see how bad it is.  The question is what to do about it??  This question deals with numerous issues that are difficult to quantify.  We are victims of our own prosperity and it is rapidly spreading around the globe.  We now have readily available food.  Our activity levels continue to decline.  The food is processed in ways that may be detrimental to our bodies.  Bad habits are passed on to our children and this is perpetuating the problem.  Obesity is becoming an issue globally.  Many will say "so what", I am fat and hurting nobody, why should you care??  What we see is the rising cost of the care that is required as we get older and fatter.  When people are young, their bodies can compensate for their weight by producing more muscle to haul the excess weight around.  They can produce more insulin so blood sugars don't rise.  Young hearts can beat more efficiently to send oxygen to the excess.  BUT, as we age, our skeleton is not capable of carrying all the excess and begins to fail.  Our pancreas cannot keep up and the fat causes insulin resistance.  Arteries become clogged with fat causing atherosclerosis, starving the heart, losing efficiency.  We then have joint breakdown, hypertension, coronary disease, adult onset (type II Diabetes), and the inability to increase activity.  These chronic problems are an expensive drain on the medical system and it effects all of us.  Not to mention all of the man and woman power we lose as a nation.

Diet and exercise of course is the way to combat the problem in the ideal world, however, this is not always a realistic solution.  Sometimes alternative methods are required.  Medical supervision is the next step using supervised diets and in some instances, medication to curb appetite.  When all of these methods fail, the next step may be a surgical alternative. 

There are many surgical procedures available for weight loss today and I will talk about the main ones briefly.  First of all, who qualifies for weight loss surgery?  Obesity is measured by body mass index or BMI.  Though not perfect, it is a way to measure a persons weight and index it for height giving us a number to use to gauge a persons weight.  To calculate your BMI, use the calculator on this site 

http://www.nhlbisupport.com/bmi/

New FDA guidelines consider a BMI above thirty to be of concern.

They consider a BMI over 40 to be morbidly obese. 

The three most commonly performed surgeries for obesity today are the Roux-en-Y gastric bypass, the gastric sleeve, and the Lap Band.  The Roux-en-Y is a good procedure for those who are very heavy, with diabetes, and need to lose weight quickly.  This bypass is good for more rapid wight loss and is better for controlling blood sugar.  This procedure is both restrictive (making a smaller stomach) and causes some diminished absorption.

The Gastric sleeve also causes more rapid weight loss.  It is restrictive by making the stomach smaller but does not have as many absorption issues.

Both of the larger surgical procedures have a short and long term complication rate.  .19% death rate and a complication rate of between 5 and 10 percent for the gastric sleeve.  For the gastric bypass the death rate is somewhere between .2 and .5 % with complication rates being 10-15% short and long term.  For the lap band, the death rate is .09% and the short and long term complication rate is 1-3%.

Next week we will focus on lap band surgery, how it's done and what you can expect...we'll have video too!!

Remember our Breast and Hair removal offers and get ready for the introductory offer on the Lap band!!!!

Very exciting!!

Breast augmentation special

-Laser HAIR Reduction....buy one area and get one F

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

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

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

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

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

http://youtu.be/0goYcY3LTqQ

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

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

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

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

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

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Watch this video....if it were only that easy to defy gravity!!!

http://youtu.be/iNQ3BHKm57o

For the final installment on wrinkles or rhytids we are going to cover procedures for people that other easier methods will not work for.  We have discussed skin care and sun avoidance for prevention, then Botox to rid ourselves of lines that are not yet permanent.  For areas that Botox will not soften, we use fillers such as Radiesse and Juvederm.  After these products have worn out their ability to improve we move into laser skin resurfacing.  When all of these tools fail....then what?  The answer is the facelift.  Sometimes only a surgical correction will do.  As we lose collagen and fat in our face and the connective tissue below the skin sags, the skin follows and becomes lose.  There are some non-invasive methods that may help, but minimally.  Face lifts come in many different types and one size does not fit all.  The oldest types only address the lose skin and have little longevity, they fail in no time because the skin stretches quickly and wrinkles and loose skin return.  Don't believe that skin stretches quickly???  Talk to a pregnant woman, skin can stretch to an incredible size, and can do it quickly.  Real face lifts address the underlying connective tissue, tightening it, and then remove the excess skin.  There are several types of lifts that are commonly used and the procedure should be individualized for each patient.  The one picked should address the specific areas that need to be lifted.  The mini face lift (s-lift, lifestyle lift, short scar lift, etc.) addresses the lower face, jowel area and some lose skin in the neck.  The vector of pull on the connective tissue and skin is up and toward the ear.  The incision starts at the temporal tuft of hair in front of the ear, follows the front contour of the ear, down around the ear lobe, and a short distance behind the ear.  This lift does have a shorter recovery time and works great for the appropriate patient.  Those with a heavy neck will need a "full lower face and neck lift".  This lift has the same incision but is is extended onto the back of the ear and into the hair line.  The vector of pull for the connective tissue and skin is not only up for the lower face, but is back and up for the neck as well.  Usually there is also a small incision under the chin to remove fat and sometimes tighten or remove some of the underlying muscle tissue.  During face lift surgery, the underlying connective tissue is tightened to correct the loosened structure that causes the face to droop and some of the fat is sculpted or liposuctioned too.  Then the skin is draped and trimmed then carefully sutured into its new location.  Facelift surgery should also address underlying bone and fat deficiencies too.  This may require cheek or chin implants, fat grafting, or other techniques.  A good face lift should not leave the patient looking stretched, it should not disrupt the normal smile or look fake.  The incisions heal very well over time and are difficult to detect.  You should look younger and well rested.  When looking for a face lift surgeon, demand to look at pictures and be sure that areas that bother you will be addressed.  Also, make sure the pictures you look at are from patients done by the surgeon you are talking to...this is an old trick...claim anothers work for your own.

At Total Body Surgical Cosmetic Surgery, Dr Swetnam has experience with numerous lifting techniques and can assist in selecting the one appropriate for you.

Come see us where cosmetic consultations are complimentary!!

Don't forget our Breast augmentation spring special and our Laser Hair Reduction Special too....Hurry though, not much time left!!

-Breast Aumentation....ACT NOW!!!

-Laser HAIR Reduction....buy one area and get one F

-LOVE YOUR LEGS......AGAIN!!!!

Next week, more about skin, brow and mid face!!