Total Body Surgical Blog

Is it possible to have a lift and augmentation at the same time?  This is a question I am asked all the time.  There are many cosmetic surgeons that feel a simultaneous procedure is not possible.  Others feel it is not safe and should not be done.  In the recent issue of Cosmetic Surgery Times, the lead article and most of the discussion was centered on this question.  In my opinion, there are very few instances when they cannot be done together. 

Why would you not want to do them both at the same time?  Good question!  The reason is multi-faceted.  First, the lift.  When we do a lift or reduction we are doing a number of things to the breast.  We are, most importantly, repositioning the nipple to a more youthful and appropriate position.  As the breast ages and is used for nursing, it looses its support and begins to sag.  The nipple falls below the fold under the breast and the upper part of the chest takes on the shape of a ski slope. We can lift the breast in this instance but it will not make the upper part of the chest full.  Once the nipple has been repositioned into a more appropriate spot, we have all the skin left below it.  This skin must be removed and the skin envelope tightened.  We now have a breast that is much perkier with a nipple position that is elevated. As you can see, there is a great improvement in shape and nipple position.  However, from this 45 degree view, the upper aspect of the breast is very sloped.  Many women don't mind this and that is fine but if upper breast fullness is desired an augmentation is required with an implant.  That's where the problem comes in.  The second problem is this; now that we have a tighter breast skin envelope we are now going to place an implant that will stretch what we have now tightened.  This can easily be done and since we have lifted the nipple we put the implant below the muscle.  What this does is fill in the upper pole of the breast and helps you regain that youthful breast that was lost.As you can see from the picture, on the lateral view and 45 degree view the upper pole is now full with good cleavage...nice result.

The third problem...do it twice and make it as identical as possible!!

That is why doing a combined lift with augmentation is challenging to many Cosmetic Surgeons.  At Total Body Surgical we do them daily with great results.  This procedure can make a tremendous change in how you look in clothes and out of them.  Come see us today for a complimentary consultation...call 918-786-7780.  Don't forget our other procedures that we have special pricing on...liposuction, breast augmentation, laser hair removal and many others.

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What is IPL?  It is a great way to remove unwanted discoloration or dyschromias on the face, chest, hands...anywhere on the body.  It is the use of Intense Pulsed Light or a flash lamp to influence the pigment cells in the skin. 

How it works is by using a specific wave length of light that targets certain color in the skin.  The color we usually are after is brown.  Age spots, liver spots, whatever you want to call them, are a problem caused by skin aging and sun damage.  They are present on sun exposed parts of the body.  The IPL is absorbed by these brown areas that then peel off and are gone.  The melanocyte (the pigment cells in the skin) is encouraged to turn off and when the skin is then protected from future sun exposure, they usually stay away.

  (melasma or brown spots from the sun)

We like to combine good quality skin care with Obagi products to speed up the effects of IPL and make them longer lasting.  The Tretinoin and hydroquinone causes the skin to grow faster and the hydroquinone turns the melanocyte off.  The IPL gets rid of the current brown spots and voila your skin begins to look like it did before the sun and baby oil did its damage!!!

Red spots on the skin can be caused from sun damage as well.  Also causing the problem are small blood vessels in the skin.  To treat these areas the wave length is different but the process is the same.  The small blood vessels are injured by the light, closed, and the vessels are broken down by the healing process.  The red areas are removed.

Usually, IPL treatments are done in a series of 3-5 treatments.  Once problem areas are gone, protection from the sun is the key to long term success.  

A treatment consists of about a 20-30 minute application of a numbing compound.  We wash that off and the actual treatment takes only a few minutes.  Hands can be treated as well and most want the decollatage or chest area treated too. 

We use the Cutera XEO system which allows us to use multiple wave lengths or combine wave lengths in a single treatment.  At Total Body Surgical we charge $150 per treatment and we have special pricing for packages of multiple treatments which is usually required.

Don't forget our breast augmentation specials on silicone and saline AND we are having great success treating nail fungus with the laser.  Our lunch time lipo special is still running also and our laser hair removal at $50.00/treatment/area can't be beat!  We have people driving from Memphis, Tn because we are so cheap!!

Call today for a consultation..918-786-7780.

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!

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.

In the past few weeks we have discussed how lasers work, removing tattoos, removing unwanted hair, and renewing the skin.  These are important uses for laser technology and as it gets better, we will see more uses pop up.  Today I want to discuss pigment issues on the face, arms, and chest. 

Why do we get them and what are they??  is picture shows melasma, aka "pregnancy mask".  It is caused by sun in combination with hormonal changes.  It is quite common and cases can vary a great deal in severity.  These changes can occur on anyone but seem to be worse in ethnic skin.  It can occur over the entire face but is the most common on the cheek area.

The second area is on the chest.  Brown spots and red spots occur with age and again.....the sun.  Sun worshipers get this and the more you worship the worse it gets.

The third area is on the hands.  Age spots, liver spots, whatever you want to call them are caused by sun damage and can be present over the entire arm.

Even if you don't worship the sun, we all get exposure during normal daily activites of walking out doors, driving, etc.  So they can occur on any of us.

How do we treat them??  First, I suggest a good skin care regimen.  This is key to getting the skin to heal and to slow down the pigmentation process.  It also prepares the skin for more aggressive treatments.  At Total Body Surgical we like to use the Obagi system for treating damaged skin.  Obagi contains tretinoin and hydroquinone.  These stimulate the skin to grow faster and shed the dead portion of the skin.  It also turns off the melanocyte or pigment cell.  Lastly, it contains a good sun screen to prevent further damage.  Once used for a short period of time, we treat these areas in a couple of ways.  First is the IPL (flashlamp or Intense Pulsed Light).  This is a machine that shoots short bursts of intense light.  The wavelength is set to target the darker colors in the skin and some red pigments.  These areas then peel off and since the pigment cells are turned off, their recurrence is much less severe.  Continued protection from the sun makes them "stay away".  Treatments are usually done in a series of 3-5 treatments and the areas gradually disappear.  We can also use laser to resurface the skin and remove pigment.  The Pearl laser is perfect for this killing "two birds with one stone".  This gives you rejuvenated skin texture, helps with fine lines and wrinkles, and rids the pigment too.  Recovery time for this treatment is only about 4-5 days.  The IPL recovery time is minor redness for about 24 hours then crusting of dark areas that will peel off.  The Obagi system causes the sensation of dryness and may cause some minor shedding of dead skin for a few weeks.

Come see us at Total Body Surgical where our staff is trained and experienced with Obagi and Skinceutical products.  We also have a full product line in the office and can get you started.

Remember our specials that are still going on too!!

Call 918-786-7780 for a complimentary cosmetic consult or fill out a contact form and we will contact you!!

More laser stuff next week!

We also have special Christmas pricing on products and gift certificates available for all laser services and skin care, Latisse and more!!

What can lasers do for your skin??  ALOT!!!!  As time goes on and the natural aging process of the skin occurs there are many changes that occur.  Ultraviolet light from the sun, pollutants in the air, pollutants in what we eat, the loss of collagen as we age, genetics, loss of fat,....and the list goes on and on.  All of these things lead to the aging of our skin causing spots, wrinkles, enlarged pores, and even skin cancers.

Here is a comparison of young and old skin...here you see how the age spots form, the outer layer thins, and fat is diminished.  On a smaller scale we would see collagen loss as well.

    What we see on the outside is this....

  How can laser treatment alter these changes??  There are a number of effects that a good laser treatment can cause making the skin look and feel younger.  Laser can tighten the skin by causing new collagen to form as the damage caused by the laser is healed.  The outer layer of skin (stratum corneum) is also thinned and made more organized by laser treatment making the skin look and feel smoother and softer.  Dark spots (age spots) or dark patches (melasma) are not only caused by sun damage but also are aggravated by hormonal changes.  When lasers are used carefully and these treatments are combined with targeted skin care and sun protection, these spots can usually be treated and removed.

Laser skin resurfacing today is safer, cheaper, and recovery times are significantly less than ever before.  At Total Body Surgical we use the Cutera Pearl laser.  This laser is unique for a number of reasons.  It is a wavelength that penetrates well into the skin but shortens recovery time.  We have the only pearl in the area.  It gives the same results as a CO2 laser but the recovery time is only around 4 days.  This means that you can wear makeup after about 4 days but will have some redness for a week or two. 

Laser resurfacing can make a huge difference in acne scarring too.  Smoothing them and helping pigment changes they can cause. 

So if you want to get rid of age spots, melasma, acne scarring, or just tighten the skin up to look younger, come see us at Total Body Surgical.  We can get you started on the new you in 2012.  Now laser treatments are as cheap as $800....much cheaper than the big city.....schedule today!!   918-786-7780...cosmetic consultations always complimentary...

Don't forget our specials too!!

Watch this video....if it were only that easy to defy gravity!!!

http://youtu.be/iNQ3BHKm57o

For the final installment on wrinkles or rhytids we are going to cover procedures for people that other easier methods will not work for.  We have discussed skin care and sun avoidance for prevention, then Botox to rid ourselves of lines that are not yet permanent.  For areas that Botox will not soften, we use fillers such as Radiesse and Juvederm.  After these products have worn out their ability to improve we move into laser skin resurfacing.  When all of these tools fail....then what?  The answer is the facelift.  Sometimes only a surgical correction will do.  As we lose collagen and fat in our face and the connective tissue below the skin sags, the skin follows and becomes lose.  There are some non-invasive methods that may help, but minimally.  Face lifts come in many different types and one size does not fit all.  The oldest types only address the lose skin and have little longevity, they fail in no time because the skin stretches quickly and wrinkles and loose skin return.  Don't believe that skin stretches quickly???  Talk to a pregnant woman, skin can stretch to an incredible size, and can do it quickly.  Real face lifts address the underlying connective tissue, tightening it, and then remove the excess skin.  There are several types of lifts that are commonly used and the procedure should be individualized for each patient.  The one picked should address the specific areas that need to be lifted.  The mini face lift (s-lift, lifestyle lift, short scar lift, etc.) addresses the lower face, jowel area and some lose skin in the neck.  The vector of pull on the connective tissue and skin is up and toward the ear.  The incision starts at the temporal tuft of hair in front of the ear, follows the front contour of the ear, down around the ear lobe, and a short distance behind the ear.  This lift does have a shorter recovery time and works great for the appropriate patient.  Those with a heavy neck will need a "full lower face and neck lift".  This lift has the same incision but is is extended onto the back of the ear and into the hair line.  The vector of pull for the connective tissue and skin is not only up for the lower face, but is back and up for the neck as well.  Usually there is also a small incision under the chin to remove fat and sometimes tighten or remove some of the underlying muscle tissue.  During face lift surgery, the underlying connective tissue is tightened to correct the loosened structure that causes the face to droop and some of the fat is sculpted or liposuctioned too.  Then the skin is draped and trimmed then carefully sutured into its new location.  Facelift surgery should also address underlying bone and fat deficiencies too.  This may require cheek or chin implants, fat grafting, or other techniques.  A good face lift should not leave the patient looking stretched, it should not disrupt the normal smile or look fake.  The incisions heal very well over time and are difficult to detect.  You should look younger and well rested.  When looking for a face lift surgeon, demand to look at pictures and be sure that areas that bother you will be addressed.  Also, make sure the pictures you look at are from patients done by the surgeon you are talking to...this is an old trick...claim anothers work for your own.

At Total Body Surgical Cosmetic Surgery, Dr Swetnam has experience with numerous lifting techniques and can assist in selecting the one appropriate for you.

Come see us where cosmetic consultations are complimentary!!

Don't forget our Breast augmentation spring special and our Laser Hair Reduction Special too....Hurry though, not much time left!!

-Breast Aumentation....ACT NOW!!!

-Laser HAIR Reduction....buy one area and get one F

-LOVE YOUR LEGS......AGAIN!!!!

Next week, more about skin, brow and mid face!!