Total Body Surgical Blog

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

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

http://youtu.be/kceaEMmi7pA

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

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

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

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

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

Talk next week!!

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

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

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

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

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

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

                                                                                      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!!!

I have seen many discussions on message boards about how to manage hyperpigmentation.  Some of the advice is good and some not so good.  First of all, what is hyperpigmentation and why do we get it??  Pigment issues are very common.  The causes are numerous but the primary cause is the sun.  When we are young and invincible we worship the sun throwing care to the wind.  This is especially true for my generation.  Oils and iodine were the staples of sun worshippers.  Nobody had heard of sun screens and everyone burned.  Now we deal with those transgressions fighting skin damage and discolorations (dyschromias).

AGE SPOTS (liver spots)

How does the sun cause pigment issues?  UV light from the sun causes the skin to protect itself by producing brown pigment or melanin.  Melanin comes from melanocytes.  People of color who originate from sunnier areas of the world produce this naturally and have darker skin.  Caucasians have to rev up the melanocyte with UV exposure.  UV light used to be from the sun but now the sun is rivaled by tanning beds and tanning goes on even in winter.  What happens is the melanocyte is started up and over numerous exposures, it doesn't stop.  This creates areas of hyper(too much)pigmentation.  Other causes are pregnancy (hormones) that lead to the "mask of pregnancy" otherwise known as melasma.  Trauma (acne scarring) especially in ethnic skin can cause dark areas.  There are also many other metabolic diseases that can lead to the problem.  ACNE DYSCHROMIAS

So what do you do about these areas.  On the sites I have been reading there are many suggestions from herbs to topical creams.  Let me tell you how I deal with dyschromias.  Since these areas are significant and are due to long term damage, they need significant therapy to heal the skin.  That means OBAGI.  The Obagi skin care system is a medical grade collection of products that heal the skin and correct the underlying damage.  MELASMA

Obagi products were developed by a dermatologist Dr. Obagi.  They are based on Tretinoin which is a cousin of Retinol and causes the skin to turn over faster making it look healthier.  The other compound is hydroquinone.  This is a compound that turns the melanocyte off decreasing the amount of pigment produced.  Also there is sunscreen to prevent future damage.  After starting the treatment with Obagi we recommend IPL treatments with the Cutera Limelight to remove the pigment that is present now.  IPL treatments target the color present in the skin and using a flash lamp the pigment is shot with bright light to break it up.  The body then absorbs it and with the hydroquinone and Tretinoin stopping the production of more pigment, it can be controlled from now on.  Protecting the skin from further UV exposure with sunscreen and maintenance Obagi keeps it away.

Come by or call 918-786-7780 for Obagi or Skinceutical products.  We can ship from our office.

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!!!

Let's talk about liposuction ....again.  If you didn't see this spot on the 40/29 Fayetteville, Arkansas news, have a look!

http://www.4029tv.com/news/30406524/detail.html

Remember "smart lipo"??  Well, it is still around but there have been improvements.  Smart lipo is when a laser is used to destroy fat cells in problem areas.  It has been touted as being less traumatic and with faster recovery times.  It became available in 2007 and was all the rage for awhile.  I was in my cosmetic training at the time and we were the first ones in Oklahoma to have a machine and we taught courses on how to use it for Cynosure, the manufacturer.  The idea was that the laser energy destroyed the fat cell and the remains were resorbed by the body.  The skin would contract and you would have a new contour.  What we found (and what many studies have shown) is the results were not as good as traditional liposuction because the volume of fat destroyed and removed was not adequate.  What has been shown is that the heat generated by the laser does cause the skin to contract better than with traditional methods.  The take home message is this...liposuction is best for removal of fat and contouring the body.....the laser energy works to heat the skin and cause it to contract to its new position.

So what is "lunch time" lipo??  It is combining liposuction, laser liposuction, and tumescent anesthesia to treat small problem areas without sedation or other anesthesia.  The key word is SMALL.  We all know, through intuition, that a procedure that involves treating a large area or multiple areas cannot be done without some recovery time AND for larger areas we sedate you for comfort and to make it a good experience.

At Total Body Surgical our Laser liposuction is done a little differently.  I use the CoolTouch laser that has a slightly different wavelength, the major difference is the cannula we use.  With traditional liposuction the fat is removed with a hollow cannula.  If the Smart Lipo is used, the laser cannula is then used to heat up the skin causing contracture of the skin.  With our machine the cannula is combined.  This allows me to liposuction and laser simultaneously, saving time with better results.

Come see us for a complimentary consultation and I will cover options with you.  What is a "small area" that would qualify for the lunch time procedure??  It would be a single area such as the neck, saddle bags, inner thighs, lower abdomen, hips.  You would arrive at the office and we would mark the problem area in question.  We would numb the area with tumescent solution and make a small incision in the skin.  The cannula is inserted and the laser turned on.  The fat is removed and the skin heated simultaneously.  You may drain from the areas for about 12 hours and we would want you to wear a "spanks" garment for 3-4 weeks.  You may have some bruising and some minor discomfort for a few days.  Please see my portfolio page to see some pictures of my patients before and after photos.  See our lipo specials too...we have great deals for the spring. 

GERD.....Sounds like something bad doesn't it??  GERD is an abbreviation for gastroesohageal reflux disease.  It describes a number of symptoms and issues that can occur when the esophagus becomes irritated by stomach acid when it spills back into the esophagus.  As we all know, the stomach is the holding chamber for what we eat.  It produces acid and is able to churn the food, acid, and mucous together to begin the process of digestion.  The stomach is protected from the acid by the mucous that it produces.  The way the food gets from the mouth to the stomach is through the esophagus.  The esophagus is a tubular structure that is covered with cells that are not capable of protecting themselves from acid.  Where the stomach and esophagus come together is called the esophago-gastric junction (EG junction).  This is where the esphagus leaves the chest and enters the abdomen.  It is supposed to be an area of higher pressure and an angle that prevents reflux of stomach contents from the stomach into the esophagus.  This image may help you understand.....

Reflux can happen to all of us.  The symptom of the problem is "heart burn".  Belching stomach contents into the esophagus exposes the lining of the esophagus to acid causing discomfort and at times, severe pain that can be severe enough to be mistaken for a heart attack. 

For most of us, this is an infrequent event and we take a Tums and it is just a bad memory.  For others, it can become a daily problem that alters their life.  Often, it is associated with a hiatal hernia.  This is a widening of the hole in the diaphragm where the esophagus leaves the chest.To treat this problem, in most cases, there are medications that can control it.  Many times, medication can eliminate the symptoms and make the problem manageable.  If not controlled, some may develope scar tissue that can lead to stricture.  Others can have cellular changes that can increase cancer risk...it is a problem that should not be ignored. 

What happens if medications don't work??  GERD and hiatal hernia can be treated surgically.  When treated this way, the problem is usually cured.  The procedure we use is called a fundoplication.  We tighten the opening in the diaphragm then wrap the upper part of the stomach around itself to re-create the angle at the end of the esophagus stopping the reflux.

  I do the procedure laparoscopically with five small incisions.  In rare cases it may require open surgery.

  Hospital stay for this procedure is a couple of days and recovery time is fairly short.

Hopefully this will give you some insight into a common disease, how to treat it medically and surgically.  See your Doctor for treatment and if you need a surgical option....come see us at Total Body Surgical where we can help.

It hurts when I eat!!!  This is a common complaint I hear almost daily.  As you know, at Total Body Surgical, we not only take care of Cosmetic Surgery patients, Vein patients, and obesity problems but General Surgical problems too.  Many times, procedures can be combined to tackle two problems at once. 

Abdominal pain comes in all forms and everyone experiences it differently.  Pain in the right side of the abdomen under the ribs is a very common problem.  This type of pain is usually the indicator of a failing gallbladder.  It starts with pain after fatty foods but may advance to pain after any food.  This pain may be felt in the back, usually at the tip of the shoulder blade.  It may also present as indigestion.  The pain usually starts as mild discomfort but as time goes on, it becomes more severe with spells becoming closer and closer together.  It may be associated with nausea and vomiting as well as changes in bowel activity.

What is a gallbladder???? 

The gallbladder is a small, pear shaped organ at the base of the liver seen in the picture above. What does it do??  It is a small storage depot for bile.  What is bile?  Bile is a salt in solution that is formed and recirculated by the biliary system in the liver.  What does it do?  Bile is a solution that helps us digest and absorb dietary fat.  Without it, fat just sails on through the digestive system and causes diarrhea.  With it, the fat is emulsified and absorbed to use for energy.  When a meal is eaten that contains fat, the normal gallbladder is stimulated to release a bolus of bile into the intestine.  The bile mixes with the fat and it is digested and absorbed.  What goes wrong to cause pain and gallstones? Pain is caused when the gallbladder is stimulated and it cannot contract properly.  This causes a cramping type of pain (colic) in the right upper abdomen, back, etc.  Bile is a salt in solution.  If you take a jar and put salt and water in it, mix it up and keep it moving, the salt stays mixed in the water.  If you stop the mixing, it can settle and form crystals at the bottom of the jar and if you roll those crystals around they can come together to form larger crystals or stones.  This is what happens to the gallbladder.  It loses its ability to release the bile when stimulated and the bile salt comes out of solution and eventually the crystals form gallstones.  The stones are a symptom of the real problem....the gallbladder itself. 

Once the symptoms become severe enough, most people will seek medical attention.  The diagnosis is made with some fairly simple tests.  First, the ultrasound.  This is a simple and pain free test to detect stones.  If stones are present and you are having symptoms the gallbladder should be removed....more about that in a minute.   If the ultrasound is negative and the symptoms are convincing, usually a HIDA scan is ordered.  This test is done to see how the gallbladder is working.  It involves an injection to fill and then another to stimulate it to work.  If it does not eject its bile normally, it should be removed.

Today the gallbladder is almost exclusively removed using a laparoscope.  This is usually an out patient procedure done through small incisions and recovery is pretty quick.  Incision placement is pretty standard... Here is a picture of gallstones....not too pretty.

  We can live normally without a gallbladder in most cases, especially a sick one.  Some people may experience a little diarrhea that usually resolves but most importantly, the pain is gone.  If the disease is not treated, the stones can escape the gallbladder and get into the duct causing bigger problems that we won't discuss here.  The gallbladder can also become infected which can be an emergency.

This procedure can also be combined with a tummy tuck when done electively.  The incisions are not made through the skin but under it so nobody will ever know....pretty cool!

Come see us at Total body surgical Cosmetic and Vein Clinic where we can discuss General surgical, Cosmetic, Vein, and Obesity issues.  Don't forget our special pricing AND keep an eye out for our soon to be announced spring roll out!

Speaking of bulges....This week we are going to shift gears a little and talk about some General surgery.  When we look at the abdomen and see something bulging, it usually means there is a hernia present.  Hernias are a very common problem.  Many people are born with them.  The most common places for this type of hernia is in the groin area (usually in men) or in the belly button or umbilicus.  These areas are where natural weaknesses are present from either the umbilical chord or where the testicles descend.  Other hernias that can form present themselves in the mid line of the abdomen or more commonly in incisions from other surgeries. 

What exactly is a hernia??  Our abdominal wall is composed of layers of muscle and connective tissue.  The connective tissue looks like a thin tendon.  All of us who have cut up meat or a chicken have noticed the shiney layer of whitish, tough tissue that surrounds the muscles....this is connective tissue or fascia.  Pound for pound it is very tough and it is responsible for holding in the contents of the abdomen and gives the muscles something to pull on when they contract.  A hernia occurs when there is a hole created in this layer and contents of the abdomen poke through that hole.  The mid line of the abdomen (especially the belly button) and the groins are the weakest areas and therefore are the most common sites for naturally occuring hernias.  Here is a picture of an inguinal hernia...

Here is a photo of what the hole looks like from the inside using a laparoscope and as you can see, with the contents removed, there is an actual hole.

  Hernias become a problem when things get stuck in them...things like intestines, fatty tissue, and other contents of the abdomen.  They can also cause discomfort due to stretching of the wall of the abdomen with straining to lift, urinate, or have a bowel movement.  Things can also become stuck, lose blood supply and die within the hernia.  Small hernias may never cause a problem.  These are the common hernias of the abdominal wall.  I won't cover the more obscure ones due to time and the others are fairly uncommon.

How do I fix them??  Today I usually fix them with laparoscopy.  This allows me to repair them with mesh that incorporates into the surrounding tissue creating a strong patch.  It also cuts down on incision size, wound infections, recovery time (minimally) and I think leads to a better repair because I can see the defect or hole better.  The mesh is placed with a great deal of overlap and tacked in place.  Meshes have small holes in them into which our bodies incorporate scar tissue making them very strong....like chain link fence on grass, the collagen holds them mesh in place making it very hard to move.  Recovery times are usually about 6-8 weeks allowing the mesh to scar in.

So, if you have a hernia, come see us at Total Body Surgical where we not only do Cosmetic surgery and Vein surgery but are professionals at General Surgery too!!

Don't forget our specials and friend us on Face Book PLEASE!!