Total Body Surgical Blog

As surgeons that wear many different hats during the week (Cosmetic Surgery, Reconstructive Surgery, Bariatric Surgery, and General Surgery), Dr. Swetnam and I are faced with constant challenges; and it is a significant challenge to keep everyone satisfied.  As one of my favorite subjects, today I'll discuss post weight loss cosmetic surgery.

Typically, bariatric surgery patients first and foremost have decided to take the plunge in changing their lives.   I heard it best this week from a patient who told me, "Dr. Miller, I am sick and tired of being sick and tired." It's a lifetime of habits that they must break: the way they eat, the way they exercise, even just the way they think. The positive repercussions of weight loss are legion.  It truly is an entire lifestyle change.  It is amazing for me to see how one positive change by a bariatric patient effects those around them.  I recently saw a patient that was 12 weeks out from a sleeve gastrectomy.

To both of our satisfaction, he had already lost 70 pounds.  On top of that, his wife had also lost 30 pounds just by following the same diet that I'd ask him to impart postoperatively.  The little cherry on top of all this icing post surgery was that their daughter had also decided to begin to make healthy food choices, resulting in weight loss as well.  It's amazing how one positive decision begets another positive decision.  Unfortunately, one of the few anticipated post weight loss "problems" (besides having to purchase a new "skinny" wardrobe), is what to do with all the extra skin that sometimes results from losing excess weight...? The thing is, not everyone ends up with excess skin.  Really, it depends on multiple factors: the patient's age (no, I didn't just call you old); how many children a patient may have had; excess roller coaster weight loss and gain over the year; and the personal skin elasticity of a patient.  The latter really making the majority of the difference.  Quite honestly, it really comes down to how you picked your parents when it comes to skin elasticity.  Genetics is key to just about everything under the sun, and skin elasticity certainly falls into that category.  So why does this matter? Think of it this way: if you have a 10 pound sack of potatoes and take out 9 pounds of those potatoes, you've got a lot of sack left over, right?  Sometimes this sack shrinks down, and other times it does not.  Again, all as a result (or lack thereof) of the degree of skin elasticity someone may or may not have.   I am often asked if exercise will help to tighten up the skin. Unfortunately, I can assure you that all the situps and jogging in the world will not help that excess skin to shrink.  So, what is the answer then?  What do I do now that I've lost this weight and my skin gets rashes between the folds?  And sure, I've lost a significant amount of weight, but my clothes still don't fit right lugging this extra skin around!  This is where the post weight loss recontouring comes into play. 

     Though not every post weight loss patient needs them, there are multiple  body contouring options for those that do post weight loss: tummy tucks, liposuction, arm lifts, breast lifts, thigh lifts, and body lifts. Typically, one or a combination of these procedures have been successfully used after weight loss surgery to refine patients’ bodies, and help them enjoy everyday activities as they envisioned at the beginning of their journey.  The most common procedure that Dr. swetnam and I do is the tummy tuck.  Essentially, that entails not just removing the excess skin present, but also tightening up the actual abdominal muscles.  We basically create an internal corset that results in a waist that many people had not seen for many, many years.  Following the tummy tuck, I would say that breast lifts are our next most common procedure post weight loss.  It's amazing to see how people's attitudes change as they continue along their weight loss journey.  Specifically, people who had become shy wall flowers virtually become alive again. Their inner personality that had been stifled for so long is reawakened.  No longer just satisfied to wear bulky sweaters and oversized tshirts to hide their insecurities, they sometimes pursue breast lifts.  Breasts that were once being tucked into their front pockets are now perky and full on the top of their chest- right where they should be.  Following breast lifts, arm lifts (sometimes termed brachioplasty in doctor-ese) would be the next most common procedure that Dr. swetnam and I perform.  It is essentially just removing extra skin and remaining fat to create a nicely contoured arm again.  Thigh lifts are much like arm lifts, except just a bit further south.  I would say that thighs are the most challenging to operate on, as God didn't create us in anticipation of having incisions in our groins (location required to lift up those thighs again).  I should mention here that the great thing about having two fellowship trained cosmetic surgeons together in a group means that more procedures can be done at the same time.  Why does that make any difference? First and foremeost, the operative time is more than halved.  This is not just better for the patient's health, but also is more cost friendly for the patient in the long run. 

     So when should a post weight loss patient consider having body contouring procedures done?  Typically, I suggest that a patient be within 80% of their weight loss goal.  Typically, this is at sometime between 12 and 18 months.  As I said, body contouring is not something that is essential from a health perspective, but rather as the end result of a long journey.  It's basically seeing the final end point result come to fruition.  It has been said more than once that we are flattered to be a part of this whole process, both as the wearing the weight loss surgeon's hat, as well as that of  the body recontouring surgeon's.  We literally know our patients inside and out!   

Come see us today for your complimentary Cosmetic consultation!!  918-786-7780 or 1-877-weight-0. 

  If you have not looked at this offer in the red box....you may be missing out on the opportunity of a lifetime!

What does skin cancer have to do with you?  Quite a bit actually.  Skin cancers are the most common cancers and that is when compared to ALL other cancers.  There are 3.5 million skin cancers diagnosed each year and another 77,000 cases of melanoma.  The incidence of all types of skin cancer are on the rise for an unknown reason.  One can speculate however, i.e., tanning beds, less coverage of skin with modern fashion, changes in our atmosphere, etc., etc.  But nobody really knows why.

As you can see from this graphic, this is a common problem.  Of course, there are several types of skin cancer that are common.  There are types that are not as common.  Then there are very rare types that are beyond the scope of this discussion.

Let's talk about the most common types first.  Basal cell carcinoma's are the most common types of skin cancer.  As the name suggests, this type of tumor arises from the basal layer of skin and is associated with UV or sun exposure.  This type of skin cancer comprises about 2.8 million of the 3.5 million skin cancers occurring in 2012.  These tumors very rarely spread to lymph nodes or other organ systems.  They start off small...

 are often ulcerated with raised edges.  Like a sore that never goes away.  They usually only spread locally and can become quite large if left alone...

  They can locally invade through bone and can require extensive surgery to remove.  It is therefore wise to seek advice while these lesions are small and easily removed.  We usually remove them surgically but they can also be removed by a Moh's procedure.  After complete removal the tumors rarely come back unless there are multiple areas involved (multi-focal tumors).  Also, the sun damage that caused the original tumor is also present on other exposed areas.  Therefore, once one is removed you must be diligent to identify and remove other tumors.

The second most common tumor, accounting for about 700,000 cases, is squamous cell carcinoma.  These tumors arise from the superficial layer of the skin and are also associated with sun exposure.  Squamous cell carcinomas involve the most superficial layer of skin.  They are usually scaley, thinner tumors in sun exposed areas.  Unlike basal cell cancers, these tumors can spread to lymph nodes in about 2-3% of cases.   This is why removal of these tumors early is a good thing. 

The big daddy of skin tumors is the melanoma.  It arises from the pigment cell in the skin called the melanocyte.  These tumors can be nasty.  About 70,000 of these tumors were diagnosed in the U.S. last year and it seems that it is on the rise.  Melanoma can spread about anywhere.  From the brain to the eye, spread of the disease is a tough problem.  These tumors can occur any place in the body that has pigment cells.This picture is pretty classic for a nodular type melanoma, irregular, varied color, and a nodule.  They can, however, look like a normal mole.  Any pigmented lesion on the skin should be watched for change or increase in size.  Treating melanoma early is critical to survival and recovery.  Early treatment means less chance of spread to other places.

There you have it, a quick primer on common skin cancers you need to look out for.  Come see us for these problems and we can help.

918-786-7780 or 1-800-weight-o.

Re-do what?  I have lots of patients that ask about how long a cosmetic procedure will hold up or "last".  I think that is a fair question in most instances.

First, the face.  When people ask me the question before a facial procedure, the analogy I like to use is daylight savings time.  When you have a facial procedure, basically, we are resetting the clock on your appearance.  You will continue to age, just like time continues to tick away in daylight savings time.  In other words, the change is permanent, but aging continues to change your appearance.  The procedure most often repeated is eyelid surgery.  Eyelids move constantly, the skin is very thin, and the eyelid skin is exposed to a great deal of sun.  The nature of the skin is to stretch and when used a great deal, it will stretch more.  Upper and lower eyelid surgery, the second time, is usually less traumatic than the first time because the fatty tissue has already been removed.  That means that only the skin is removed in the second procedure.  The second procedure most often repeated is the facelift.  Again, after the first procedure, as we continue to mature, the skin continues to stretch and the floppy neck or jowel may return after 15-20 years.  A second face lift is easier because of scar tissue that forms gives us more tissue to work with so sutures hold better and dissection is less involved.  The procedure that holds up the best is the endoscopic brow lift.  Since the low brow is usually heredity related, once the brow is lifted it tends to stay put.

Second to discuss are body procedures.  Tummy tucks seldom need re-doing unless you have severe changes in weight or have a pregnancy after the initial procedure.  That is why we encourage women to be done reproducing before considering a tummy tuck.

The same is true of most other body procedures, thigh or butt lifts, arm reductions, etc.  Liposuction is seldom repeated in the same area except for touch-up prodedures since most of the fat cells in that area have been removed.  Of course, if you do gain weight, it will appear in other areas and the repeat procedure will be in that area instead of the old site.  In other words, if you have your abdomen done then gain 20 pounds, you may notice that your arms or thighs are where the weight is going.  The reason is, the fat cells that used to store fat in the abdominal wall are gone or greatly diminished in number and fat can no longer be stored there...it must go somewhere else.

The third is the breast.  This is a whole other animal sorry to say.  The breast is somewhat unpredictable.  For breast augmentations, they look great in younger women and generally hold up well with two caveats....pregnancy and weight changes.  Most women look fantastic with their breast implants... until pregnancy.  Then, in some, the wheels come off.  The breast inlarges during and after pregnancy, breast feeding occurs, and for some, the process repeats itself over and over.  After several pregnancies and several years the breasts start looking sad.

They droop over the implants or sometimes take the implants with them.  In these cases, the only solution (after a tubal or vasectomy) is a breast lift, removing the old implants, and deciding whether to replace the implants or not.  The only way to get fullness in the upper part of the breast in this situation is with an implant so it just depends on the final outcome you are looking for.  Of course implants can always be placed later.

Hope this helps answer your questions and don't forget all of the special pricing we have going on with hair removal, tummy tuck, and weight loss surgeries!!

Call for complimentary cosmetic consultation 918-786-7780 or 1-877-weight-0.  We can't wait to hear from you!

For the past several weeks I have taken the time to reflect.  Some of the time has been spent venting here, mostly, the time has been spent on my back deck looking at the lake and re-evaluating some things.  This week I wanted to touch on a few points that I think are important and how they relate to Cosmetic Surgery and Bariatric Surgery...namely, happiness and fulfillment.

Now first of all, I am not a philosopher.  I did take several classes in the subject in college and I have read philosophy since, but I am not a pro. 

As children, all of us start off pretty happy.  We really have no point of reference to create sadness.  Whether we are rich or poor, have good parents or not, are good looking or not as good looking as we think we should be, we are usually content with our existance.  Then society steps in to tell us all the reasons we should not be happy.  The TV tells us that if we don't have this gizmo or that, this car or that car, blah blah blah, we are inferior to others.  The process worsens in school as peer pressure takes over, and the process goes on and on as we get older. 

We all reach points in our life where we are not happy with some portion of ourself or our situation.  Maybe we are overweight, maybe there is something about our body that is making us unhappy, maybe it's our job, family, belief system, or a combination.  I personally think that it is OK to be unhappy about some things and it is OK to strive to improve them.  For instance, if you were unhappy with your employment situation, you could start investigating new career options, start taking some classes, if that is what is needed, and start a new career path.  If your marriage is not so great, you and your spouse can seek counseling sessions to find out why your compatability has waned and start communicating better.  We have all seen situations like these where people improve their lives dramatically with a little self improvement or education.

What if we are too heavy?  Of course starting off with exercise and diet may help.  Physician directed diets and medication are also accepted methods and are, for some, successful.  However, when they fail, it is also perfectly acceptable to seek a surgical option.  My philosophy is fairly simple when it comes to bariatric surgery and similar to the philosophy when treating drug abusers....if you don't get it under control, it's going to kill you, so do whatever it takes to get it under control.  For any addiction problem, it may mean drug rehabilitation and for the morbidly obese, it means bariatric surgery.  The two problems are very similar as both deal with controlling desires and changing lifestyle.  Rehab is a tool, and so is weight loss surgery.  Let me tell you, once a person loses 150 lbs, they become happy.  They realize that the extra person they have carried around for all those years has made their life miserable, socially, physically, and otherwise.  Life for these people becomes much more fulfilling because they are happier, their self image restored.  They are now able to get out of the house, socialize, play with their children or grand children, work and become better providers.  Most of all, they get rid of the stigmata of obesity that society tags them with.  I find this an exciting and life changing event.  We have one life to live so live it to the fullest.  If your weight is prohibiting this and all else has failed....what's stopping you?  Don't let those that don't have the problem dictate what you do.  Obesity is a dangerous problem that WILL shorten your life so fix the problem if you can.

Cosmetic surgery falls more into the "want to" category, but is no less important.  People that have some sort of Cosmetic problem are no less self conscious than the obese person.  Whether it is breasts that are too large or too small, stretch marks after children or a sagging lower abdomen, or facial changes that occur with age, all can cause a person to be less able to fully participate in society, be happy, and fulfilled.  We have the ability to correct these problems so why not be happy.  Of course most say that "happiness comes from within" which is a statement I believe in.  However, if fixing a Cosmetic problem gives one the self esteem to let that happiness out....I say fix it!  Again, don't allow others to dictate what will make you happy, and remember that most of them would have something done if they could.

Our lives are a gift from God.  It is our job to make the best of that life.  Live every day like it is your last, and do whatever it takes to be fulfilled and happy, even if that means fixing something.  Love deeply, laugh out loud, cry when you need to, make good friends and cherish them, treat others like they are family (but love your family a little more), hug everyone, and most of all, thank God every day for what you do have in life.  Pretty simple, but now you know my philosophy. 

Come see us....we will treat you right, and Cosmetic Consultations are always complimentary.

918-786-7780 or 1-877-weight-0.

Let's take a break from liposuction this week, we'll wear that out some more later!!

Dr Miller and I just did an interview with the Joplin television station and the topic was addressing extra fat and skin in the upper arms with arm reduction.  I will put a link on the website after it runs if you want to have a look.

First of all...What the heck is an arm reduction?  Also known as a brachioplasty, it is the removal of skin or fat from the upper arm.  

As you can see from the picture, the upper arm has very loose skin with a little excess fatty tissue.  Compared to the lower arm, it looks "odd" and makes some people very self conscious.   Also, when trying to buy clothes, people will avoid sleeveless attire and buying sleeved clothes is hard due to the large diameter of the upper arm.

The image above shows where we usually make the incision.  I normally will liposuction the upper arm to get the maximum reduction, then remove the excess skin.

This photo shows a good before and after.  The results are pretty striking.  The down side in Cosmetic surgery, and the trade off, is always the scar, but these tend to lighten up with time and for most, it is worth it.  Some make the incision along the lower part of the upper arm but I personally think the least visible area is as shown.

Who wants an arm reduction??  There is no single answer to that question.  I guess the easiest person to pin point is the one who has had massive weight loss after dieting or weight loss surgery.  In some, the skin tightens to a satisfactory level so it does not hang, however, in others, they lose the weight, the skin sags and becomes a problem.  In summer fashions with short or no sleeves, the excessive skin can make someone very self conscious.  Some people just gain weight in there arms.  This, of course, is related to your genetic layout.  For some, liposuction will do.  Which procedure is best for you?  That depends on the amount of skin and its quality.  Skin that has stretch marks, is already thin but still hangs, or where there is just too much, will probably benefit from reduction as liposuction can only cause a small amount of skin contraction no matter what technique is used.

The procedure can be done in the office for smaller arms or in the hospital for larger ones.  It usually takes us about 2 hours to complete and is done as an out patient.  Personally, I use drains only in the larger arms and all others I don't.  We like for you to be very careful and baby the incisions for about 6 weeks so the scar that does form is minimal.  Due to the high motion of the area, we will tend to revise these scars more often than most in the office to make them look nicer.  The first time they are closed, there is tension on the wound and this tension, combined with motion can make the scars wider than we like.  When revising, we are only working with the scar.  There is much less tension after revision and they will heal better in most cases.  Many times, we only need to revise a portion of the scar which also makes it easier.

Why the rise in people wanting a reduction?  I don't know the exact reason but I think awareness is one thing.  Many did not know there was a solution to the problem but now do. The other reason is the rise in obesity and weight loss surgery.  With massive weight loss surgery and the desire to "get the old body back" an arm reduction is the only solution for some people.  

Come see us at Total Body Surgical where we are experts at all types of post weight loss surgery....we also do the weight loss surgery, so we have the experience. 

Call 918-786-7780 today or 1-866-weight0 for a consultation at no cost to you.  With you, we will decide which procedure is best.  

Don't forget our laser liposuction deal...$999 per area....can't beat that....call today!!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

918-786-7780 or 1-866-weight0

LAST CALL for spring breast augmentation special pricing!!  It ends on the 30th at midnight.  You don't have to have your surgery before then, just get your quote that will be good for 60 days.  Hit this button to get all of the details.

This week, I wanted to address some of the more frequently asked questions about liposuction.  Most people have a number of questions and if you have one I don't cover, email me your question to jeffswetnam@yahoo.com and I will do my best to find an answer for you.

Liposuction, as covered last week, has really grown up over the past several years.  Used to be, lipo was done under general anesthesia, in a hospital, with significant blood loss, often requiring transfusion.  This all changed when the tumescent techniques were developed using lidocaine and epinephrine.  What this does is provide an anesthetic "block" to the area with the lidocaine (the same stuff used by the dentist to allow them to drill teeth) and limit blood loss with epinephrine as it causes constriction of blood vessels and slows the absorption of the lidocaine.  Once these techniques were perfected, liposuction pretty much moved to an office procedure.  With the addition of lasers, ultrasound, and other ancillary energy, we are now able to affect how the skin reacts to removing the underlying fatty tissue, i.e., we can make it contract and lose some of its sagginess.

Many questions remain.  One of the most often asked questions is "what happens if I gain weight after liposuction?"  To understand the answer to that question, you need to understand the reasoning behind the answer.  Theoretically, we are all born with a finite number of fat cells.  These cells increase or decrease in size as our weight goes up or down.  With liposuction, we remove a population of these cells in the area treated.  Therefore, if you gain weight, you cannot gain as much in the area treated, so, you will gain it in other places.  5-10 pounds probably will go unnoticed but 20 or 30, and you will have significant changes in other areas.  You may also notice lumpiness in the treated areas as the fat cells that are left (we cannot remove them all) will grow in size.

The second question often asked is will my skin shrink?  This is also a great question.  I look at the quality of the skin and evaluate it prior to recommending liposuction.  If the skin in the lower abdomen say, has numerous stretch marks, wrinkles and scars, then liposuction may not be the best choice as we are expecting poor quality skin to contract and smooth out. For the abdomen, in the person mentioned above, I would probably recommend a tummy tuck instead. Skin that has no stretch marks, no scars, and is good quality anyway will usually respond well.  We use the laser to promote the skin contracture and also to make the procedure less traumatic. 

The third question is usually, how much can I do at one time??  The answer to this question requires a multiple part answer.  First, how big are the areas?  We can do multiple small areas at one time.  Larger areas may have to be devided up.  Why??  Well, it depends on how much lidocaine we have to use, and, how much fat we are going to remove.  Of course, there are limits on the amount of lidocaine we can use based on a persons weight.  We also usually don't remove more than 4 liters of fat (two, 2 liter coke bottles full) at each setting as rates of complication increase exponentially when 4 liters is exceeded. I try to estimate how much fatty tissue will be removed from each area and make a plan accordingly. 

Well, that's enough for this week!  Again, if you have a question you would like addressed about liposuction, or anything else, email me and we'll do our best to address it.

Remember, Cosmetic consults are complimentary so call 918-786-7780 or 1-866-weight0 TODAY!!   

Don't miss the last days of the spring breast augmentation special at TBS...$3500 until April 30!! What this means is that you must consult with one of us, get an official quote, and then book your procedure by the 30, not have the surgery.  We will honor the quote for 60 days, so it's NOT TOO LATE!! Hit the button below for details...

This weeks article, by Dr Miller covers a great deal about how we do liposuction.  We are kicking off another springtime, body improvement, get in shape for summer deal, this time with great pricing on liposuction...the smart way.   

LIPOSUCTION: FACTS AND MYTHS

GENETICS

Liposuction, like all cosmetic procedures, is a combination of skill and artistry.  It sounds hokey, but just as each person is taught they are a snowflake in grade school, every individual requires a very personalized approach when addressing areas of fat.  Now, typically speaking, many women usually tend to focus their problem areas as being the lower abdomen, flanks (the dreaded muffin top), and arms.  Meanwhile, guys tend to focus on their chest and belly.  Obviously, crossover does occur regarding areas; and to be perfectly honest, it all depends on how we pick our parents! 

AM I A CANDIDATE?

Many people will begin to notice collections of fat, post baby, (men included) that they just can’t get rid of.  Others will turn to liposuction when they have pesky areas that just won’t disappear,  no matter how much exercise and dieting they do.  Still others want extra help in appearance for a wedding or class reunion coming up.  Whatever the case, liposuction is a spectacular avenue to help someone on the  road to the body that they envision.

JUST A TOOL

It should be emphasized that liposuction is only a tool.  Specifically, it is NOT a weightloss technique.  Without a doubt, one will lose weight from the procedure, but its main focus is actually to shape by removal of fat. In addition, once a person has  liposuction, that area where fat is removed means that it is gone for good.  However, this doesn’t mean you’re free to go and gain weight- quite the contrary!  In fact, weight gain will go to other areas of your body, making it look abnormal.  We encourage our liposuction patients to utilize this opportunity as a complete jumpstart to a new and healthy lifestyle. From a very positive point of view, if fat is removed by liposuction from problematic areas, this also means that calories burned by diet and exercise in the future will then be focused on other areas, rather than those where fat has been removed. 

WHAT IS THE PROCESS?

STEP 1

Essentially, the way liposuction is done at Total Body Surgical is a 3 step process.  Though it is not commonly practiced outside of the East and West Coasts, our liposuction is usually performed with what is called the  tumescent technique.  It has also been termed, “lunchtime lipo”, “Smartlipo”, or “laser lipo”.  Patients remain awake throughout the procedure, receiving local anesthesia in the areas of treatment. This allows the patient to communicate with the physician throughout the procedure. It also helps physicians provide great results by allowing them to easily position the patient in the best way possible to treat each area. For those that may be concerned about being awake during the procedure, patients are provided medications to assist in their relaxation and comfort.

In addition, the tumescent technique allows the patient to avoid the general anesthetic that is so hard on your health.  Many times, the recovery from a surgery is not so much related to the procedure, but rather to the administration of the general anesthetic.  Essentially, tumescent technique cuts your recovery time by at least 50%.  Meaning, it is a quicker return to work and your daily activities (typically 3-7 days). 

STEP 2

After getting the patient numb, the second step of the process begins.  Many people have heard the term, “Smartlipo”, or “laser lipo”, which is essentially the utilization of a laser to melt the fat in the  problematic areas being addressed.  Utilization of the laser also decreases swelling, bruising, and also helps to speed recovery.  This is especially true when compared to the old way that liposuction has traditionally been performed. The micro-laser is so tiny that it can contour small areas that were more difficult to treat in the past, such as upper arms and under the chin. This technique smoothes out the work done with the power-assisted micro cannulas and stimulates collagen formation which can help the skin tighten, producing a smooth final appearance to the treated areas.

STEP 3

After the fat is melted, then the fun part begins.  Meaning, all of the melted fat is then gently  removed  by a very small suction tube.  This is where inches are lost, and new waistlines are formed.  The majority of the time during the procedure is spent on this stage.

Am I A Candidate?

Most importantly, you must be in good health. Ideally, not having any active diseases or significant pre-existing medical conditions is best. 

Make sure you  have realistic expectations of the outcome of liposuction. Open communication is absolutely imperative! You have to clearly understand what your desired results are and be able to convey  this information to your surgeon.  Then, discussion of your goals with your surgeon to determine what can feasibly be done to reach all or part of this goal will be essential.

Further, the elasticity of your skin plays a huge role in whether you are a good candidate. You should have good elasticity, so that your skin is able to shrink  back to its former tightness once the fat is removed. As we get older, have babies, and yo-yo diet, our skin loses its elastic property.  Think of it this way:  if you took a brand new pair of underwear out of the package and stretched out the elastic waistband for 2 hours, then let it go, it wouldn’t snap back to the way it was when you took it out of the package brand new, would it?  Our skin is much the same.  In addition regarding your skin, if you had a 10 pound sack of potatoes and you took out 8 pounds, you’d have quite a lot of sack left over, right?  Obviously, we want that sack to shrink up. Analogously, when you take a large amount of fat out of an area, you’ll have the tendency to have extra skin.  This is where using the laser comes into play. Utilizing the laser (remember stage 2 of the procedure) optimizes the chances that this will happen.  However, the overwhelming factor of whether or not this skin will shrink back  is by far and away your genetics.  How we picked our parents plays a huge roll in this life!  The presence of stretch marks is a flashing neon sign that your skin is not what it used to be, and may not shrink up as tight as it would have when you were 18.  However, many patients really just desire to look better in clothes.  Having extra skin after removal of fat will not effect this.  Again, discussion of realistic expectations between you and your surgeon is a must!

Hit this button to see the great offer we have going until May 30!!

Hard to tell by the weather, but Spring IS here, not only by dates, but soon the warmer weather too.  In keeping with our Spring $3500 breast augmentation offer, we will discuss breasts.  There are a little over 3 weeks left to take advantage, so click on the button below to get details and fill out the contact form.  We'll get back with you.  Or call 918-786-7780 or 1-866-weight0 to schedule an appointment that will be complimentary.

I think we have about beat this subject to death but wanted to go into a little more detail about approaches to implant placement and some of our thoughts.  This will help YOU decide.  You deciding seems to be a recurring theme here, but you need to happy with your choice of implants and how they are placed.  Understand that we are happy if you are happy!!  The size you choose, the insertion approach you choose is all about you, not us.  We are here to help guide you in making your decisions.  Dr Miller and I have a great deal of experience with these choices and can help guide you.  Trish, Janet, Rachel, and Wendy also have experience, some have had this type of surgery and they are here to help too.  They are also WOMEN, this gives them a leg up, as politically incorrect as that statement is!!

A couple of things that have been glossed over you need to know about....

1.  Sizing:  When it comes to the size of implant you want or need, there are several factors involved.  Your height and weight.  Your build, thin, athletic, or larger build, your current breast size, and your desired size after augmentation.  We always hear comments on implant size based on what the internet says or friends comments, or the size someone else received.  You can usually throw all of these comments and suggestions out of the window.  Why??  You are unique.  The amount of breast tissue you are starting out with is not exactly the same as everyone else.  The size of your chest is not the same as everyone else.  You are taller or shorter, thinner or fluffier than everyone else.....one size DOES NOT fit all in this situation.  We start off by talking to you to get an idea what you want.  We then measure your current breast location, how big the current breast is, and the size of your chest. This helps us to figure out a range of implants that will be right for you.  If you have 100cc of natural breast tissue and want to increase to a 400cc breast, we need to look at implants around 300cc.  If your friend started out with 300cc of natural tissue and ended up with a 200cc implant, she may think your 300 is "large" when if you consider where you both started....it is about the same...right?.....right.  We will allow you to try different sizes on, in your clothes, so you can get an idea what you will look like.  We will also help you choose the style of implant you want.

There is a new higher profile not pictured here.

2.  Placement approach:  How do you want the implant placed??  Also an important question.  The options for saline are, armpit (transaxillary), below the breast (inframammary), through the nipple (peri-areolar), or through the belly button (TUBA).

 Arm pit incision-saline or silicone.

The incision is only 2-4cm, not this big!! Saline or silicone.

incision around the nipple. Saline or silicone.

Silicone cannot be placed through the belly button.

We all have our preferences but we are here to help you decide what YOUR preference is.  Here are the ones I don't like.  Peri-areolar approach is less ideal because it can cause sensation changes around the nipple and leaves a scar on the breast.  I also am not too fond of the TUBA.  It has a higher incidence of assymetry and can also cause unsightly scarring around the belly button.  My first choice is trans-axillary (through the arm pit), Dr Miller's is under the breast.  There are several reasons why I like the arm pit...one is that there is no scar on the breast.  I choose a small crease in the arm pit that is there in everyone and use it to make my incision.  This usually heals well within 6-12 months and you can barely find it....no scars on the breast and the scar that is there is concealed.  My second choice is the infra-mammary incision.  This incision is probably the easiest one to use as it is the least remote from where the implants are placed.  It is also a commonly used incision later if implants are replaced or any other work on the capsule is necessary.  The down side....an incision on the breast, even though they usually heal very well.

So don't forget to call 918-786-7780 or 1-866-weight0 to make your appointment.  With only a little over 3 weeks left, the time is now.  As long as you book before April 31, you can pick any date after and still get the special pricing.  Call TODAY!!

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

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

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

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

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

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

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

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

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

melasma 

poikiloderma 

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

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

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