Total Body Surgical Blog

Let's have some fun today.  It's been a little while since we had a little audience participation and I think it is time to change that.  Sooo, it's test time again!! 

Here are the rules:

1.  Look at the picture and see what you think would help.  (those of you who come here often will find it easy...you are educated!!).

2.  The choices will be between using Botox, a Filler of some sort, laser, or a surgical procedure.

You may elect to combine the use of these tools and that is OK.  I do it all the time.  Today though, let's not get too complicated.  In my analysis of the patient I will give you some ideas on what other things would be good for the patient.  I need to feel useful in some way!!

Always remember, there is no right answer, because, in Cosmetic surgery everything is elective.  You can always choose to do nothing.  However, there are wrong answers.  Wrong answers are when you plan to do more than the patient needs or wants.  My job is to steer people away from unecessary procedures and only do what's needed or desired...today, that's your job.  Good luck!!

Example #1: 

Here we have a 40'ish female with no other medical problems.  She complains that she looks "old" and wants a face lift or something to help her look the way she feels.  Look at her closely.  What do you think??

What would you recommend:

1.  Botox  2.  some type of filler  3.  laser  4.  a surgical procedure

Example #2:

40'ish young lady who complains about the lower part of her face sagging.  Her friends have told her that you have helped them and she should come talk to you about what could be done.  You would recommend???

  Your recommendation??

1.  Botox  2.  a filler of some type  3.  laser  4.  a surgical procedure

Example #3:

A 54 year old lady who is disgusted with her neck and just thinks she looks OLD!!  She says that cost is no obstacle and wants it all fixed, or injected, or something! 

 And the winner is....

1.  Botox  2.  some type of filler 3.  laser  4.  a surgical procedure

Example #4:

28 year old female who states her boyfriend says she has "wrinkles around her mouth".  She is concearned about this and wants to know what you think....

  Here she is...

1.  Botox  2.  Some type of filler  3.  laser  4.  surgical procedure  5.  get a new boyfriend!

Example 5:

A 65 year old widow comes to you and says she has finished mourning the loss of her husband and wants to look younger so she can "get out there".

  Very nice lady....funny too....what would you recommend??

1.  Botox  2.  some type of filler  3. laser  4. Surgical procedure  5.  Birth control

Well, let's see how you did.  On number one if you said Botox, that would be a great start.  Most people want to start small.  Botox would get rid of the lines around the eyes and in the upper face.  She will eventually probably want a brow lift to eliminate the lines and the cause of them but Botox is fairly cheap and less invasive.

On number two, I would say Botox and some type of filler.  This combination is great for softening wrinkles in the upper face and getting rid of nasolabial folds as this lady has.  She has good facial structure and her skin is in good shape.  This will make her very happy and not cost a fortune.

On number three, I would recommend a surgical procedure or two.  Looking at the "hooding" over her eyes, she would benefit greatly from a brow lift.  It will take years off of her appearance.  She also has the "turkey gobbler" neck and jowling but her neck is not heavy.  I would recommend a mini lower face and neck lift as well.  She will be very happy!

On number four....get a new boyfriend of course.  We see people like this sometimes and my job is to DO NOTHING.  She needs to be told how beautiful she is and just how silly it would be to do anything to change that.  Unfortunately, in many cases, these people will find someone to mess things up.  It's sad.

Number five would need a brow lift, upper eyelids, face lift, and I would also recommend full face laser to treat the discolorations and fine lines on the rest of the face.

I hope you did well on the quiz today, and enjoyed using your own evaluation skills.  If you like, let me know how you scored and if you have anything you would like addressed, send that too.

Call us at 918-786-7780 or 1-877-weight-0 to make an appointment.

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!

  Do you ever feel like this?  What is a brow lift and when do I need one?  How do you know if it's the eyelid or the brow?  This week I hope to give you the information you need if you have these questions, or know someone who does.

  Many people show up to the office wanting their eyelids done.  The eyelids droop, look bad, and sometimes even effect their vision.  The question is..this, is it the brow, the lids, or a combination of the two?

If you look closely at this picture, what do you see?  First, it looks like her lids are drooping.  On closer inspection, the problem is a little more subtle.  If you look at the brow position, it is very low.  There is a hood over the outside of the eyelid and out over the outside of the eye.  This is a tell-tale sign....lateral hooding.  The second thing you notice is how low the eyebrow is in relation to the eye.  In females, the normal position should be above the boney rim of the upper eye and should have an arch to it that is highest at about the outer iris (colored part of the eye).  Her brow is far from being in the proper position...it is very low.  She may come asking to have her eyelids fixed, and without further examination, she may be right, but the primary problem is her brow.

Brow ptosis, or droop, is a problem that can be multi-factorial.  It is partially hereditary and is added to, as a problem, by facial fat loss.  It can cause cosmetic issues, making you look older, tired all the time, and causes wrinkles in the forehead due to over-use of the muscles in the area so you can see.  Brow ptosis can also cause visual field problems.  Our peripheral vision is dependant on a clear field of vision, up, down, medial and lateral.  What the droop can cause is an occlusion to the vision.  Once the brow falls significantly, it is like having blinders on a horse, you can only see straight ahead!

In many cases, the brow droop is accompanied by upper lid laxity (blepharachalasia) as well.  When this happens, we try to address both problems at once.  For older patients with visual problems, we establish the problem exists first by doing a "visual field" test.  This establishes if your vision is actually effected by the extra or low tissue.  Then the lid or brow is taped out of the way and the test repeated.  This allows us to tell if removing eyelid tissue or elevating the brow is indicated, or if both are indicated.(Visual field testing.)

 This is a great example of an eyelid problem only.  If you look closely you see that the brow position is exactly as we discussed.  The brow is in a good position as far as it relates to the boney part of the eye socket, and it is arched nicely.  Also note that there is no lateral hooding present as we saw in the previous picture.  It is the eyelids that are the problem and a simple blepharoplasty is sufficient to fix this.  This is a great result by the way, off of google images.

 A blepharoplasty means removing skin from the upper eyelids and often a small amount of fat.  This gives you back the lid platform for eye make-up, makes you look less tired, and is very rejuvenating, knocking several years off of your appearance.  I usually do these in the office, mostly under local.  It takes about 45 minutes or so, you go home after, there usually is no more than minor bruising, and after healing several months, you can't even see the scar.  It is a great procedure.

When a brow lift is done for cosmetic purposes.  I do them using a scope and a camera.  Some people still make a large incision on the scalp but I think the scope gives great results without significantly moving the hair line and without a big scar.

This picture depicts where the small incisions are placed for a brow lift.  We shave no hair, the hair line stays the same, and the results are just as good as the old big incision.

This shows a nice result from a brow lift.  She looks much younger and the hoods that she had before are now gone.  The brow position is arched and good...no surprised look.

If you are dealing with these problems, come see us today at Total Body Surgical.  We can help...call 918-786-7780 or 1-877-weight-0.

A good friend asked me to talk about fillers this week and I promised I would, so here goes.

First of all, what is a filler and why would someone want to use one??  Fillers are just what the name sounds like.  As we age, we lose volume in our face.  We lose it around the eyes, in the cheek area, and in the folds around the mouth and lips.  This is caused by hormonal changes and in many cases, genetics plays a significant role.

  As you can see in this graffic, as volume is lost, the skin begins to respond to gravity and "folds" in typical spots start to form.  Nasolabial folds are the most common, forming around the base of the nose to the corners of the mouth.  Secondly, "bags" begin to form under the eyes.  This is due to shrinkage of the fat pads in the cheek area that, in younger people, "windowshade" the fat pad under the eye.  This creates the dark circle under the eye which is really shadowing, as light is blocked by the overhanging fat pad.  The other commonly effected areas are the "marionette lines" at the lower corners of the mouth and vertical lip lines.  One other common complaint is thinning of the lips and loss of the youthful shape of the lip.

This picture depicts the "cone of youth" and how aging turns it into a box.  Again, most of this is due to loss of volume and loss of skin elasticity.

Now that we have covered what happens, what can be done about it?  There are a few ways we can correct or reverse the aging process.  The first thing I recommend is good skin care.  It wouldn't be right to fix up a vintage car and not re-paint the thing would it?  You want your skin to look as youthful as possible and I think Obagi is as good as it gets for that.

Second, we have to increase volume.  Even when we do face lifts to remove excess skin, most of us will add volume to fill up the upper part of the face...this is youthful.

The first and best way to increase volume is with facial implants.  They are solid silicone and never go away....one time and that's it.  The second best way is with fat grafting.  We use your fat, process it, and place it back in the face.  This is good because it can last a pretty long time...5-7 years.  The third way is with fillers.

Fillers have been around quite a long time.  First came collagen fillers that only lasted about 3-4 months and required skin testing.  We now have them that last a year or more and can be used in anyone.  The most commonly recognized one is Juvederm.  It is made of cross-linked Hyaluronic acid (HA).  HA is a substance that is present between our cells naturally.  Juvederm is clear and almost jelly like.

  It can be used literally anywhere in the face.  We use it to fill the cheek area, the nasolabial folds, marrionette lines, and lips.  It can also be used to correct nasal deformities or acne scars.  Think of it as putting dirt in a hole in your yard without disturbing the grass.  It is used to fill deformities or add volume to the cheek area, the nasolabial folds or marrionette lines.  It can be used to make lips larger or reshape them.    The second type of filler non-occuring in the body and made of a calcium compound mixed with a sugar based carrier.  This filler is good for volumizing but can only be used in deeper tissues. 

Radiesse is great for liquid face lifts where we place volume into the cheek area, lifting the face and restoring volume.  It can be used in nasolabial folds and carefully in marrionette lines.  It cannot be used in lips or in the dermis (skin).  Most other fillers on the market are made of HA, regardless of the name, except Artefill (made of collagen and spheres of solid material) and Sculptra (made of a powder material that causes collagen to form).  These two materials are made to inject deeply and last 5+ years.  All fillers have advantages and disadvantages.  You must consult with your injector to know which one is best to get the result you want.

My preferences are for Juvederm and Radiesse, for shorter term fillers.  I use silikon 1000 for my long term filler as it never goes away.  I use it to make great looking lips that stay.  I do small injections a month or so apart to get the right amount of correction.  Hope this helps everyone.  We love fillers and do them very well.  Call today and come see me at 918-786-7780.  All cosmetic consultations are complimentary.

Latest news coverage for Total Body Surgical and Green Country Bariatrics from Joplin, Mo.,.....check it out....
http://www.koamtv.com/story/20349961/integris-grove-fights-back-against-obesity-with-help-of-new-surgeon

Vaginal Rejuvenation....well, don't expect a lot of pictures for this one folks!!  A very touchy subject to be sure.  I'll try to get through this without offending anyone, here goes.

Why vaginal rejuvenation?  The simple fact is, the vagina does a lot of hard work during pregnancy and delivery.  The tissues in the vaginal wall, the labia, the cervix all stretch to incredible size to allow the infant access to the outside world.  The aftermath can leave changes that do not resolve.  For men, imagine trying to stretch your lips around a watermelon then returning to normal....impossible right?  My point exactly.  The vagina and labia undero chronic changes and never return to the pre partum state.

What changes occur?  The outer appearance changes that occur are numerous, but the biggest ones that most women notice are a thinning of the mons area with a loss of fat in the mons and labia majora.  Secondly the labia minora becomes effaced (thinner) and become stretched and longer.  In some cases the labia minora may protrude beyond the labia majora.  The third change that most women notice is a change in the coloration of the labia majora.  It can become much darker, losing its original pinkish hue and becoming brown or in some cases almost black.

The inner changes that can occur are also many and can be complex.  As the infant travels down the vagina, it stretches to a very large size.  Hormones cause the tissue to become very elastic to allow this to occur, however, damage may be done, especially when large babies deliver.  One of the common internal changes that occurs is the enlarging of the vaginal diameter.  This can have long term effects when it comes to sexual satisfaction for both the woman and her partner.  Other things that can happen that are a little more severe and beyond the scope of Cosmetic Surgery are cystoceles and rectoceles.  Cystocele occurs when the connective tissue of the front of the vagina tears and allows the bladder to fall into the vagina.  This can cause difficulty in holding the urine and also cause an unsightly bulging to the front of the vagina.  Rectocele is when the same thing happens in the back wall of the vagina and the rectum bulges in.  These problems can occur simultaneously and may require a surgical procedure to fix, if they are bad enough.  The common problem we deal with is just trying to tighten the vagina after it has dilated, recovered from delivery, but just not to the pre delivery state.

How does this effect Cosmetic appearance??  Well, I'd show you some pictures, but for the sake of modesty, I'll pass.  With newer summer fashions, swim wear, tighter shorts and pants, in many cases the changes can be seen under clothing.  Also, many women are self conscious and are embarassed when naked with their partner, not to mention the decrease in sexual satisfaction.

What does this have to do with Cosmetic Surgery??  Our goal at Total Body Surgical is to take care of all of the Cosmetic needs of our patients and this is a Cosmetic need.  What we do to fix the problem is using one or two procedures.  They can be used individually or in combination.  The first is the labiaplasty.  What this involves is removing the extra and discolored labia.  Labiaplasty leads to a more pleasing appearance to the external genitalia and can also help with the appearance in clothing.  This is a quick procedure with very little down time and in many women, it can be done in the office with some IV sedation.  Healing in this area is very quick and there is only minimal discomfort.  Added to this, to address the thinning of the Mons area, we will often do some fat grafting in the area to make the outer appearance of the mons and labia majora look more youthful...it can make a huge difference.  Second is addressing vaginal laxity.  How do you deal with this??  We make a very small incision at the base of the back of the vagina and insert a laser fiber.  The laser energy causes the vagina to tighten over the next few weeks.  We also tighten the entroitus a little and close the skin.  All of these procedures can be combined and can be done in the office for select patients.  Others, can be put to sleep in the Operating room if that is desired.

What you have when finished is very much like what we see in a face lift.  No fundamental change in the anatomy, just the appearance you had before age and children altered it.  Also, an improvement in the vaginal function.

We recommend that the procedure ONLY be done after having ALL of your children!  It is also a procedure that can be combined with other GYN surgeries, like tubal ligation or hysterectomy.

Come see us today and we'll talk about it....918-786-7780.

Click on the buttons to see our special offers!

What does Christmas have to do with Cosmetic Surgery??? Well let's talk about it. 

Christmas is rapidly approaching believe it or not, it is only a few weeks away.  Now is the time to start thinking about gifts and what can be done for the new year.  Many don't think about anything Cosmetic, but let me help you change your mind.  Instead of that sweater, tie, or other gift that will be worn on Christmas day and then never seen again, how about giving something that can be seen every day!! There are a number of things that are affordable and can make you or your loved ones look and feel better.....much more useful than a sweater!!

First:  Laser hair removal.  We have pricing on laser hair removal that are the best in the country.  If you have young ladies in your life, this is a great gift.  At $50 per area per treatment you can give the gift that keeps on giving for about $300 per area.  No more razors, always ready for summer wear...what a gift.  For guys, we must bring this up carefully but if you listen well, the opening usually comes up so pay attention.  We can remove hair on the face, bikini area, and under the arms on women and for men, chest and back hair removal is all the rage.  Call the office at 918-786-7780 and we can get you a nice gift certificate to put under the tree!

Second:  Botox or dermal fillers.  Everyone has heard of Botox and many of us use it regularly.  It is a great help in reducing wrinkles in the face, stopping excessive sweating, and relieving headaches.  In many cases our loved ones are already using it so why not pre buy and save some money!!  We have special pricing on pre-bought Botox at $9 per unit.  If you figure the average number of units at 30, that is $270 per treatment....very affordable.  The treatments take about twenty minutes and last up to 6 months.  You can take care of his or her whole year with one gift certificate.  Dermal fillers like Radiesse or Juvederm can also be pre purchased at a special price.  These are used to fill nasolabial folds (the wrinkles between the base of the nose and the mouth) and marionette lines (wrinkles from the side of the mouth).  They last about a year.  We also do the so called liquid face lift that fills the cheek area getting rid of lines under the eyes and in the cheek.  This is very rejeuvenating and less traumatic than the real thing.  We are offering a syringe of filler for $400 (usual price $500) and if you purchase more we will lower the price on multiple syringes.  Either of these gifts will get you big kisses.  Call us at 918-786-7780 and we will get you a nice certificate.

Third:  Venous sclerotherapy.  This is the time to get rid of those ugly spider veins before we are back in shorts.  These treatments are done in the office and are fairly quick.  Normally we charge $350 per session but for Christmas, we will lower that price to $300.  What a nice gift to give....getting your legs back, being able to wear shorts again without embarassment.  For a nice gift certificate, call 918-786-7780.

Fourth:  Liposuction.  This can be a little more of a touchy subject but if your significant other is continually complaining about belly fat, saddle bags, love handles, muffin top, fat arms, any other area or combination of areas, they are asking for liposuction but don't know how to say it.  Smaller areas are perfect for liposuction with short recovery time and amazing results.  We have all the specialized equipment too.  Laser liposuction is amazing at helping tighten up the skin after removing the fat.  We will give you a 10% discount on the first area and a 20% discount on a second area.  That is up to a 30% discount on two areas of liposuction.  That means that you can give a gift that will change those complaints into complements.

Fifth:  Breast augmentation.  College students, wives, and girlfriends are always talking about having breast implants to improve self image by improving appearance.  What better gift to give.  We have the best pricing on silicone and saline implants right here in Grove.  Christmas is a great time to schedule and take advantage of the winter to heal up and be ready for summer. 

There you have it...some great ideas for Christmas gift that I guarantee will be appreciated.  Dr Miller and I or our nurses are also ready to help if you have questions about what is appropriate.  Call us today at 918-786-7780 and GET YOUR SHOPPING DONE early for once!!!!

HAPPY NEW YEAR!!  After a two week hiatus....it is good to be back.  2012 will be an exciting year.  Lots of changes on the horizon for all of us.  Total Body Surgical will be entering its second year of service to Northeastern Oklahoma and the surrounding areas. Our success is all thanks to you.  Unless the Mayans are correct, we expect this year to be a banner one with many new changes to serve you better and MAYBE a few surprises!! 

New changes are happening this year for us.  This installment is to explain them.  Next week we will get back into the meat.

First of all, we will be adding to our team in the next few weeks.  We will be adding an ultrasound tech.  Why??  Well, as many of you know, I have been doing the pre and post treatment vein ultrasounds and quite frankly, it has become too busy for me to do them and keep up with everything else.  Our new tech will specialize in venous studies and as things in the vein center continue to grow, will take over more responsibilities with insurance and the daily running of the center.  Venous disease is way underdiagnosed and the Northeastern Oklahoma, Arkansas and Missouri are underserved when it comes to the newer techniques in varicose vein treatments.  We offer them all and as the word gets out and we continue to get great results we will need more help.

Second, we will be adding a new person at the front desk.  This is greatly needed to serve you quicker when you come in, answer phones better, and allow us to provide the service you have come to expect at Total Body Surgical.  We strive to be the best at everything we do.  We hate to make people wait and know your time is important.  I feel that the addition of our new staff will help us get closer to our goal.  Be assured that these new faces will be just as friendly and nice as Mekala, Myranda, and Janet are now.... or we won't hire them!!

Third, physical changes.  As many of you know, our corner in Grove has been undergoing massive change for the better.  The old hospital is gone, the old intersection....gone...and the new shopping center is well under construction.  The intersection, which has hindered access for several months is now finished with new curbing and asphalt.  It looks great and will serve all of us much better than the old one....thank you Grove!!  We plan to make some cosmetic improvements to the outer office, and, as you know, the interior is very nice.

Fourth, I will be making more YouTube clips.  We plan to film procedures, pre and post op instructions and more.  We will attach them to the web site so that you will have a better understanding of what goes on during your procedure and help address your questions and fears.

These are the changes we are working on for 2012.  Keep and eye out for the surprises!! 

The next few weeks I will talk a little about common General Surgical problems.  These may not be as fun as the Cosmetic and Vein discussions but are just as important, if not more so.

First we will talk about one of the more common problems...the gallbladder, then hernias, then endoscopy.  By that time we will be heading into spring.  I am working on some great pricing for "mommy makeovers" for spring that will include breast work, tummy tuck, and liposuction....very exciting.

Talk next week....Happy New Year!!

New blogs starting after the new year.

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

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

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

What's the point???  Well, there are several.  This week I would like to summarize the past several weeks.  As obesity becomes a growing world wide problem, obesity surgery is becoming a common thing.  The common procedures are the Lap Band, the gastric sleeve, and the Roux en Y bypass.  They all have their place in the treatment of obesity.  As the procedures and massive weight loss occur, the desire and need for body contouring increase.  If you did not see the previous installments, go check them out to see what procedures are most common and in greater detail.  This installment will cover some of the high points of more detailed discussions of weeks past.

1.  Your weight should be stable for a minimum of 12 months.  Lose the weight, get where you want to be and stay there for at least 12 months before having surgery.  Doing it this way gives better results and leads to fewer repeats.

2.  You must be healthy.  Cosmetic surgery is not "minor" surgery.  People can have complications and even death from this type of surgery.  Make sure you have a healthy heart, lungs, kidneys, and that diabetes and hypertension are controlled prior to your surgery.

3.  You cannot have it all done at once.  These surgeries can be very taxing on the surgeon and you.  Sit down and figure out, in order, what bothers you the most.  Then discuss with your surgeon a strategy to attack the areas in a planned way that makes sense and is safe.  Sometimes procedures can be combined but don't get in too big of a hurry, be safe.

4.  Know what is available.  The most common procedures I see, in order, are:

-Tummy tuck

-Breast lift

-Arm reduction

-Butt lift

-Face lift

-Thigh lift

-Back lift

5.  Seek out a safe and well trained professional....nuff said.

Hope this helps.  New topic next week.  If there is anything you would like to hear about, drop me a line, jeffswetnam@yahoo.com and I will try to address it.

Thanks for tuning in and don't miss our specials.  New ones coming for the fall to so keep looking here.

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

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

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

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

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

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

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

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

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