Total Body Surgical Blog

Onchomycosis, also known as nail fungus, is a very common problem.

It is a problem that can make people very self conscious and is often very difficult to treat effectively. The cause is a fungus called tinea unguum.  The fungus infects the nail bed where it is protected, moist, warm, and has a good supply of food.  Common risk factors for fungal infection are:

 

• Getting manicures and pedicures using utensils that have been used on other people

• Getting minor skin or nail injuries

• Having a nail deformity or nail disease

• Having moist skin for a long time

• Poorly functioning immune system (Diabetes and smoking)

• Wearing closed-in footwear

Symptoms

Nail changes on one or more nails (usually toenails):

• Brittleness

• Change in nail shape

• Crumbling of the outside edges of the nail

• Debris trapped under the nail

• Loosening or lifting up of the nail

• Loss of luster and shine

• Thickening of the nail

• White or yellow streaks on the side of the nailThese changes in the nail are unsightly and can lead to discomfort, and to the inability to wear certain footwear due to the thickness of the nail.  Until recently, the problem was very difficult to treat.  Creams, vinegar, nail removal, were the only options.  Then came oral medications:

Over-the-counter creams and ointments generally do not help treat this condition.

Prescription antifungal medicines taken by mouth may help clear the fungus.

• You will need to take the medicine for about 2 to 3 months for toenails; a shorter time for fingernails

• Fluconazole griseofulvin, terbinafine, and itraconazole are used to treat this condition.

• Your health care provider will do lab tests to check for liver damage while you are taking these medicines.

In some cases, the health care provider was required to remove the nail. Nails grow slowly. Even if treatment is successful, a new, clearer nail may take up to a year to grow in. AND the treatment effectiveness is only about 50%.

So why am I writing this???  Well, there is a new treatment that is being used that is about 80% effective and I can give it to you.  NO blood tests, NO risk of liver damage, NO anesthesia, NO pain.  Also, very quick and usually only takes two treatments.  It is done using FDA approved laser treatment. 

The treatment is done in the office and takes about 15 minutes.  We use a 1064 YAG laser that warms the nail and kills the fungus.  We treat all 10 toes and repeat the treatment in 6 weeks.  Usually the nail re-grows and looks normal in 3-6 months.  NO anesthesia is required and can be done on the day of your first visit is you schedule.  If more than 2 treatments are required, the cost is greatly reduced.

The expense of the medications and lab work required could exceed $1000.00 and, again, was only 50% effective.  The laser treatment for all toes, both feet, two treatments is $800.00...very affordable.

Book your appointment today and tell them it is for treatment of nail fungus so we can schedule laser time.  We will have you back in open toed shoes or sandles before next summer!!!  Call 918-786-7780 or fill out the contact form and we will call you!

Don't forget out lap band special AND we are starting a new liposuction promotion until Christmas...get one area 10% off and get a second smaller area FREE!!!                          

Click on image to see lipo special offer!

For the last installment on veins in this series let's discuss the pesky spider vein.  These veins are very common and can be unsightly.  I probably hear more complaints about spider veins than any other vein problems.  They can occur in young women, old women, and every age in between.  The cause of these veins which occur superficially in the skin is usually hereditary and they are aggravated by standing for long periods.  They can occur alone or may be associated with a bigger underlying vein issue.  The reason they enlarge and become visible is increased venous pressure.  Good news is, when these veins occur, they can be treated. At Total Body Surgical, we have a number of methods for treatment.  First, if the problem is extensive, we go out of our way to ensure that the cause is not just a symptom of an underlying bigger vein problem.  At the Total Body Surgical Vein Center we use ultrasound to make sure the larger veins are healthy.  If the spider veins are limited, or if the larger venous system is healthy, we then focus on the cosmetic treatment of the spider veins themselves.  Dr Swetnam usually uses sclerotherapy to eliminate them.  This is a minor procedure that is performed in the office.  It is fairly quick and with minimal discomfort.  A solution is injected into the spider vein that causes inflammation of the lining of the vein, eventually causing your body to remove it so that it can no longer function, or be seen.   This may take a few treatments and requires the wearing of compression stockings for about 2 weeks after injection and avoidance of strenuous exercise and hot tubs for that time as well.  In some instances, some brownish discoloration can occur around the site that usually resolves.  Some ulceration of the skin can also occur which heals well but can cause some minor scarring.  If the larger veins are diseased and the spider veins are injected, they will recur.  If we do a diagnostic ultrasound that shows the larger veins are not functioning, we treat those first with laser closure.  This stops the pressure and then allows us to treat the smaller veins with sclerotherapy successfully.I also use the Vein Light to isolate the "reticular" or connecting veins that feed the spider vein.  This allows me to see what is feeding the group of spider veins and inject it as well. 

For much smaller areas I sometimes will use the YAG laser to close them.  This is relatively quick.  I also use the laser when treating facial veins.  These commonly occur around the base of the nose, on the cheeks and chin.  They are very common in people with rosacea. 

Treatment of spider veins is an ongoing process and should be maintained.  Most people with significant spider veins will eventually meet criteria for treatment of the larger veins that are the root of the problem.  Patients with facial veins will also need maintenance.

Next week....fungus amungus.....the newest treatment for toe nail fungus!!!

Keep an eye out for new specials for fall!!!!

Come see us at Total Body Surgical for Obagi products, Skinceuticals, Botox, Juvederm, and all laser services.  Coming soon....laser tattoo removal!!

918-786-7780

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

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

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

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

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

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

 

After weight loss surgery, as we discussed the past few weeks, skin can become loose and not return to its pre-surgical state.  Last week we talked about tummy tucks, removing skin from the abdomen and tightening the underlying muscles.  This recreates the shape and tightness of the abdomen that is lost after weight loss.  Another common procedure that is requested after massive weight loss is the arm reduction or brachioplasty.  Many people gain excessive weight in their arms and after the weight is gone the skin can hang.  Many describe these at "bat wings".  The unsightly nature of this excess skin becomes hard to conceal and makes wearing short sleeves, tank tops, or anything other than a long sleeve top impossible.

What to do about it??  There are some non-invasive ways to tighten up the skin but these are usually inadequate after weight loss.  It requires skin removal, just like with the tummy tuck.  The up side to this procedure is the reclaimation of your original arm shape with the ability to wear more fashionable clothing and the loss of the "bat wings".  The down side, as with most cosmetic procedures is the scar that occurs on the medial aspect of the upper arm. Photos compliments of the ASPS.

Fortunately, this scar is on the inside of the arm and becomes less and less visible with time. 

Come see us at Total Body Surgical where we do ALL post weight loss body contouring.

ALSO, be sure to take advantage of the Lap band introduction at INTEGRIS Total Body Surgical, and the Breast Augmentation Special through the end of July!!

Last week we talked about who is ready for Cosmetic Surgery after weight loss surgery.  If you have not read that installment, read it first.  Today we are talking about one of the most common procedures desired after weight loss and that procedure is the tummy tuck or abdominoplasty.

After massive weight loss, either surgical or diet, many people have excess skin in the upper and lower abdomen.  This is not only unsightly but can cause to infections, rashes, and leads to the problem of where to put it in clothing etc. In a few cases, insurance may even cover the removal, but in most instances, it is considered Cosmetic and remains uncovered.  When covered by insurance, usually only the lower hanging skin is removed and this skin and fat is called a pannus.  The procedure is called a panniculectomy and is meant only to remove the skin that is hanging and prone to infection.  It is not meant to be a cosmetic procedure.

In a true tummy tuck, the entire abdomen is addressed.  The skin in the upper and lower abdomen is addressed and the underlying muscle is tightened.  The idea is to regain the appearance and shape that was lost with weight gain. 

There are two common types of tummy tuck.  The first is the full tummy tuck that is probably the most common.  The incision is across the lower abdomen and around the belly button.  I like to keep the incision as low as possible to conceal it below garments and swimwear.  The belly button stays where God put it but the skin and fat is elevated, pulled down and removed.  Before re-attaching, the muscle is tightened in the middle of the abdomen to flatten the stomach and get rid of any laxity in the connective tissue.  The upper skin is then pulled tight and sewn to the lower skin.  Finally, the belly button stalk is located and a new opening is created in the overlying skin and it is sewn in place.  A plastic tube drain is placed in the space under the skin and it stays in place until this space stops producing fluid....about a week.  During this time I advise patients to stay bent over a little until the skin stretches.  A garment is also worn for several weeks. 

Full Tummy Tuck

For people that already have an incision in the middle of the upper abdomen, an anchor abdominoplasty or Fleur Des lis tummy tuck may be more appropriate.  This can tighten the waist as well.  Here is a video that demonstrates the procedure.

Anchor or Fleur Des Lis tummy tuck

The second most common type of tummy tuck is the lipoabdominoplasty or Avelar abdominoplasty.  In this technique, the fat is removed with liposuction until the skin becomes loose.  The incisions are made in the lower abdomen and around the belly button, the skin is pulled down and removed.  A tunnel is made to allow tightening of the underlying connective tissue and a drain is placed. I could not find a good video for this procedure....guess I need to make one!!

It just depends on your specific needs and wants when choosing a technique.  Many cosmetic and plastic surgeons try to make everyone fit into one procedure.  Find one that can offer choices and be sure to look at before and after pictures AND be sure they are the Doctors work and not someone elses!!

Come see us at Total Body Surgical Cosmetic Surgery to investigate all of the options.  Don't miss out on our special pricing on a number of procedures.  Press the tabs below to see them.

Next week...the arm reduction. Thanks for reading!!

 

 

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

  Last week on the Total Body Surgical Cosmetic Surgery blog we talked about wrinkles and how good skin care and Botox can make a big difference.  This week we will take a look at the common fillers that can be used.

Below is one of the commonly used scales to measure and quantify the severity of wrinkles and skin damage.

Group	Classification	Typical Age	Description	Skin Characteristics
I	Mild	28-35	No wrinkles	Early Photoaging: mild pigment changes, no keratosis, minimal wrinkles, minimal or no makeup
II	Moderate	35-50	Wrinkles in motion	Early to Moderate Photoaging: Early brown spots visible, keratosis palpable but not visible, parallel smile lines begin to appear, wears some foundation
III	Advanced	50-65	Wrinkles at rest	Advanced Photoaging: Obvious discolorations, visible capillaries (telangiectasias), visible keratosis, wears heavier foundation always
IV	Severe	60-75	Only wrinkles	Severe Photoaging: Yellow-gray skin color, prior skin malignancies, wrinkles throughout - no normal skin, cannot wear makeup because it cakes and cracks

Class II we would usually use Botox or Dysport because slowing the underlying muscles will usually eliminate the wrinkle as long as it is maintained.

Class III wrinkles will usually require "filling" as they are present at rest and are more or less permanent fixtures.  Filling them will not remove the wrinkle 100% but will go a long way toward making them tolerable.

There are many fillers on the market and thank goodness most of them now last a year or more.  This is in contrast to only 5 or 6 years ago when a filler would work for 2-4 months.  Many techniques can be nearly peramanant.

Hyaluronic acid fillers such as Juvederm and Perlane are great all around fillers that can be used nearly anywhere in the body.  This is because it is a naturally occurring substance in the body and is colorless.  They cause very little collagen production and the newer ones contain lidocaine which is a nice plus for the patient and injector.  These are the most widely used products.

Radiesse is another filler that is made of small calcium hydroxyapetite beads in a sugar based carrier.  This filler is limited in its use and should not be used in the lip or superficially anywhere.  It is great for larger volume fills in the cheek and nasolabial fold.  It works by causing your body to form collagen in the treated areas. It should last 12 to 18 months but will need some supplementation in that time.

Other common fillers are Sculptra which is poly L lactic acid can be used to create volume in the cheeks but this is a much slower process than the other two.

More permanent fillers are fat and silicone.  Fat harvesting and grafting has become common all over the body, but is very popular in the face.  Fat is harvested, treated and placed in areas where fat has disappeared over time.  There is some variability in the percentage of the fat that lives and therefore the procedure may need repeating. Lastly, silicone.  Silicone has received a bad name.  There are countless examples of low grade silicone used in too large a quantity to create a terrible result.  At Total Body Surgical, I have a great deal of experience with silicone.  We use only the best quality silikon 1000 that is manufactured by Alcon and made for use in the eye.  It works great for augmenting lips, filling areas of imperfection on the nose, and some acne scarring.

Next week....we'll address pigment issues!!  Come see us at Total Body Surgical.  Mention this blog and get $10.00per unit botox....That's a good price now!!

 

 

Eyelashes....you don't have to go to these extremes!!! Forget false eyelashes, extensions, and mascara that makes you look like a horror movie actress at the end of the day. There are now products on the market that can make your lashes grow....and no it is not like Rogain, creating only fuzz. These products make your lashes grow in a matter of days. They get darker, longer and thicker, to impressive levels. Several companies are producing products that work. I will talk briefly about Latisse as it is the one most people know about. Latisse is the same medication that is used in Lumigan. Lumigan has been around for a long time as a treatment for glaucoma. It was noted that one of the side effects of Lumigan use was eyelash growth. We, in the Cosmetic industry, used to use Lumigan to lengthen eyelashes but we used the drops IN the eye. One of the side effects was a permanent change in eye color. This did not effect women with brown or black eyes and women with very blue eyes had little problem either. It is the women with blue eyes that have darker pigment mixed in and these are the people that may have darkening of the iris. Latisse is applied topically to the lashes and it seems to work just as well as the drops if not better. The nice thing is that the side effect of a darkening iris is still present but very rare as very little medicine actually gets in the eye. Once you begin to use the product, you will notice a change in your lashes within a week in most cases. You will see new lashes starting to grow and the old ones start to darken and become thicker. You will be amazed and love the results. Many girls actually have to trim them. It is truly one of those OMG products that WORKS!! Those of you that know me know that I refuse to promote something that does not work and this product does. There are other rival products being marketed right now but I have little experience with them. OBAGI has a new product that we are dying to try and there are several others. I will give you my recommendations after we gain some experience. We carry Latisse at our office and our daily price is $100.00. Our girls will teach you some tricks on how to extend the life of your purchase too. We can ship the product to you if you like and soon it will be availble through our on line store once we get it up and running. Come see us and don't forget our look Grand on Grand breast augmentation promotion through May: $3699. for saline and $4899. for silicone implants. www.totalbodysurgical.net 918-786-7780 Friend us on Facebook!!