Total Body Surgical Blog

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.

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Dr. Jeff Swetnam of INTEGRIS Total Body Surgical

Here is the newest (or maybe oldest) form of breast augmentation.

 WHAT!!!!!

Don't believe it.....I don't either.  If all you had to do is think about breasts to make them bigger, most guys would have Triple D's!!

The last week in this blog, we discussed the different types of commercially available breast implant materials.  The natural types that are now being touted are fat grafting.  Some people are having great results with this and we are too.  However, it can be somewhat unpredictable and you have to have liposuction to get the fat.  Some women have so little fat that it is impossible to get enough to make a difference.

The time honored and gold standard is the breast implant.  These can be placed through several approaches, quickly, and with very predictable results.  Please see previous blogs and videos to get the facts on implants that are currently on the market.

My philosophy is to give you the size and shape that YOU want.  I hear stories all the time about Doctors that give their patients the size and shape that he or she feels will "fit them the best" and most of these women are too big or too small.

The way implants are sized is by the shape and size of the chest wall we are trying to fit.  You would not pull a semi truck into your garage at home now would you....  We don't worry about cc's as much as we are concerned with matching your anatomy and the look you want.  When you come for a consult at INTEGRIS Total Body Surgical we will measure first, then allow you to try on a range of implants that match your body, put on shirts that you want to wear and allow YOU to decide.  Bring friends, significant others, or husbands to help you.  The girls in the office can also give their opinions if you like. 

We hope you will come see us for a complimentary consultation.

918-786-7780

Now through June, breast augmentations are starting at $3699.00.  Look GRAND on Grand this summer!!