Total Body Surgical Blog

Sorry about the late post this week!  Spent the weekend in Oxford, MS at the Ole Miss, Arkansas game.  Oxford is a great place to visit and I recommend it to all.  The game was fun.  One of my daughters went to Ole Miss and the other is currently a Hog!!!

This week we are going to discuss the unusual uses of fillers.  Last week I talked about the normal uses around the mouth and in the nasolabial folds.  I hope you all got to read it. 

There are a number of uses for fillers that are a little out of the main stream.  The first is in the nose.  There are a number of people that present with complaints of imperfections in the shape of their nose and they are not ready for rhinoplasty, OR, they have had a less than perfect rhinoplasty and have persistant defects.  In these cases I will use Radiesse or Silikon 1000 to help re-shape the bridge of the nose or fill defects.  With Silikon 1000 the fix is permanent and therefore I like to correct in stages so as not to overcorrect.  Fillers are a great way to a non surgical rhinoplasty.

A second out of the mainstream use of fillers is for cheek augmentation and filling the nasojugal fold....the line we get below the eye from the corner of the eye onto the cheek.  This is done in those that do not want an implant or fat grafting.  The filler is essentially placed where an implant would sit over the cheek bone.  It is a great way to rejuvenate the mid face without surgery.  It is done in the office and usually requires several syringes of product.  I usually use Radiesse as it offers more volume per syringe for the same price.  I like to call this the liquid face lift.  It is not perfect but does do a good job.

The third use is in rejuvenating the hands.  As we age, we not only lose fat in the face, we also lose it in our hands.  Many times we work on our face and body then forget the hands. Hands age quickly due to sun exposure.  Fillers or fat can do a great deal to make the hands look much younger.

The fourth place is for acne scarring.  Laser resurfacing can do a great deal to smooth out scarring that occurs from acne.  When they become too deep for the laser....fillers can help.  I usually use Juvederm or Silikon 1000 in very small amounts to help level these areas.  In some cases subcision or release of the scar must be done first and this is done in the office with some local anesthetic.

The last place I will talk about for fillers is the lips.  Believe it or not....they get smaller too!!  Adding volume to the lips is a great way to rejuvenate.  Voluptuous lips are what all the girls want!!  I like to use Juvederm, and for those who want a permanent fix...Silikon 1000 in a gradual fill.  Both are great and can make you look outstanding....

Enough about fillers I think.

Remember our special offers on fillers, liposuction, lap bands and treatment of toe nail fungus!!

918-786-7780...and like us on Facebook Please!

The past two weeks we have discussed the common and uncommon uses for Botox and similar neurotoxins in the management of facial and neck wrinkles.

The next question is "what are my options when Botox doesn't work"??

The next easy step to correcting a wrinkle that is too deep for Botox is a Dermal Filler.  Traditionally, fillers are used for diminishing nasolabial folds as pictured here....

These are lines that form from the lower edge of the nose to the lateral edge of the mouth.  They occur as fat is lost from the mid face and the skin begins to sag.  Lipoatrophy, or fat loss occurs with age and hormonal changes in us all.  This volume should be replaced, and that is what dermal fillers are used for.

The second most common area is the oral commissure or Marrionette line at the lower lateral edge of the mouth.  In this picture there are many other areas shown and fillers can be used for most of them with glabellar lines, perioral lines, and lip augmentation rounding out the most common uses.

What are fillers anyway?  Dermal fillers have been around for some time.  They have gotten progressively better with time, the biggest improvement has been the length of time they last.  Most modern fillers stay around for a year or more and some are made to stay around forever.

One of the most common fillers is Juvederm.

It is made of hyaluronic acid (a normally occurring substance in the body) that has been cross linked to make the molecule very large.  This makes it hard for the body to digest it so it stays around longer...up to 12 months.  It also has a numbing agent within the product to ease the discomfort during injection.  Juvederm and other hyaluronic acid fillers can be used almost anywhere in the face including the lip.

Another common filler is Radiesse Radiesse is made of Calcium hydroxylapatite in a sugar base that promotes collagen development when injected.  It cannot be used in certain areas of the face but is a great product for the more common areas except lips.  It is mixed with lidocaine to make injections nearly painless as well.

I think both of these products are very good and at Total Body Surgical we use them both, sometimes in combination. 

Of the permanent fillers, I like Silikon 1000.  Silikon 1000 is made to use in the eye but due to its high quality, it can be used as a filler if used carefully.  Of course it is off label and not FDA approved.  I like to use it to volumize lips and to treat some acne scars.  It works great when done properly and is permanent.  This can be very economical over time.

Next week I will talk about the more unconventional uses for fillers....some you may not have thought of.

Come see us today at Total Body Surgical and take advantage of our special offers.  Call 918-786-7780 where Cosmetic Consultations are complimentary!

NOW UNTIL THANKSGIVING....BUY ONE FILLER (Juvederm or Radiesse)AND GET THE SECOND ONE AT HALF PRICE!!!!!

Last week we discussed (and hopefully dispelled) many of the myths about the use of Botox.  The FDA  has approved the cosmetic use of Botox in the  Glabellar region or the area between the eyes and forehead.

However, off label uses for the medicine have become common place.  I like to use it around the eyes to elevate the brow, treat crows feet, and to open the eye to show more of the iris or colored part of the eye.  Botox is VERY effective in these areas and due to the small size of the muscles, it requires only a very small amount.

  Notice the "crows feet" around the outer aspect of the eye and the hypertrophy or enlargement of the muscle below the eye.  Botox works extremely well to smooth these areas creating a more youthful look.

Another area that can be improved is the neck.  Many men and women develop banding of the muscles that lead to wrinkling of the skin.  Botox relaxes the muscles that cause the banding and the skin smooths very well.

A third area is around the mouth.

Many people start to form lines around the mouth due to the pursing motion of the muscles around the lips and loss of volume.  Smoking, using a straw, pursing the lips all create the lines.  When used carefully, Botox can help smooth these areas.  Add some volume and the mouth appears much younger.  Be warned that it may create some temporary weakness and this should be expected.  The chin area can also be smoothed with botox.

Another off label use is for Masseter muscle enlargement.

This can occur due to genetics or teeth clenching.  Botox can weaken the muscle and allow it to shrink giving the face a less angular look.

Botox can also be used to treat hyperhydrosis or excessive sweating.  The best area to treat is the under arm but it is also effective on the palms and feet.  Many people have this problem that cannot be resolved with anti-perspirants.  A simple test done at the time of treatment shows where the sweating is most profuse and small amounts of botox are injected.  It is very effective and seems to have good longevity....6 months to a year.

These are just a few of the off label uses for Botox.  There are many others and more are tried all of the time. 

Next week I will discuss volume replacement with dermal fillers and other things such as fat or implants.

Be sure to check our liposuction, nail fungus, and lap band offers.  Many are taking advantage of them, saving significant money, and getting GREAT results!!

Cosmetic consultations are complimentary so call today 918-786-7780 or fill out our contact form!

Sorry everyone!! An Internet crash at the Grove address forced me to delay writing this installment.  The double edged sword of modern technology. 

This week I want to discuss removing the large varicose veins.  This was once done with larger incisions that left unsightly scarring.  We now perform what is called the European Micro phlebectomy.  What that means is that the veins are removed using a technique developed in Europe.  The difference is that this technique leaves very little scarring and is much more Cosmetically appealing than the old way.

The large varicosities that we see in the leg is usually not the actual disease.  As discussed in previous blogs, this disease is from incompetent valves in the saphenous system in most cases.  These big and ropey veins develope in response to the increased pressure in veins deeper in the leg.  Once closed with the laser, the deeper veins no longer feed these enlarged "branches" or varicosities.  When this happens a number of problems can occur, they can become painful, they can clot and cause phlebitis, they can cause skin color changes.  These problems will usually resolve with time but can be miserable. 

How is the procedure done??  After closing the system that is feeding the visible varicose vein, the large ropey veins are marked with a marker with the patient standing.  Local anesthesia is injected into the areas to be removed and in our office, IV sedation is given.  Once the local has taken effect, very small incisions are made and small instruments are used to grab the vein, elevate it, and tease it out from under the skin.  It is completely removed if possible.  The incisions are no more than a couple of millimeters in size (less than an eighth of an inch).  No stitches are placed, and a compression dressing is applied with Coban to hold pressure.  Some minor bruising may occur that lasts for a few days, the wounds may leak minimally for about 24 hr or so.  We have patients walk out of the office and most experience very little discomfort after.  The wounds heal very well and usually go unnoticed after 6 months or so.  Once removed, the painful and ugly source of embarassment is gone.

Next week....Cosmetic sclerotherapy and how to get rid of spider veins.

Call Total Body Surgical today for YOUR vein evaluation 918-786-7780!

To continue the conversation about body contouring after weight loss surgery, this installment will address the thighs and knees.  After the weight loss, the tummy tuck, the arm reduction, the breast lift, and the butt lift, many people are ready to address the thighs.  You may not need all of these procedures, you may only need one or two.  If more than one procedure is required, I usually save the thighs for last.  Why??  Well, to be honest, it is a difficult recovery because of where the incisions must be placed.  Do you need a thigh lift, or will liposuction cure the problem?  It depends on the amount of extra skin that is present.  Too much sagging skin will not contract with liposuction and will need to be removed.  A problem area of fat depostion can be liposuctioned. 

Incisions for a thigh lift are in the groin, following the contour of the upper thigh.  To lift the knee, the incision travels down the inner thigh, making a kind of "T".  Removing this skin allows us to make the thigh tighter and removing the skin in the groin allows us to pull the skin up getting rid of the sagging and re-shaping the thighs.  The incisions are placed in a high motion area that stays moist and is close to areas that can be difficult to keep clean.  These factors can make wound healing a challenge in the best of circumstances.....thigh lifts are not for the faint of heart.  They can, however, make a huge difference in appearance and wardrobe. 

Come see us at Total Body Surgical for all of your body contouring needs.  Time is running out to take advantage of the Breast and lap band specials so don't miss them!!

More next week.

What about butts after massive weight loss?? 

Many changes occur after weight loss.  We have been discussing arms, abdomen, breast and when to proceed with these procedures after weight loss or weight loss surgery. 

The problem with massive weight loss is that protein stores in the body are consumed after sugar and before fat.  We all want to lose the fat first but this is not generally what happens.  Fat is the bodies way of long term energy storage and is mobilized only after other sources are used up or low.  In massive weight loss, especially after bypass surgery, muscle protein is mobilized as the weight loss proceeds.  One of the biggest muscles in our bodies is the muscles in the butt.....the gluteal muscles.  Think about it....these muscles are the lever that allow us to stand, walk, use stairs, etc., it is not just a seat pad!!  As weight loss proceeds, this muscle gets smaller as protein is mobilized and used for energy.  As this occurs, of course, the skin sags and the butt ends up on the upper thighs.  Many people want their butt back to its original position.  The way we put it back is with the butt lift.  It is similar to a tummy tuck for the rear end.  The incision is placed along the upper Gluteal region and the skin is lifted up to remove the excess.  In some instances an implant can also be placed to give more volume to the butt.  The one pictured here has had a previous tummy tuck as well.

Come see us at Total Body Surgical for all of your after bariatric surgery needs.  Also, don't forget our breast augmentation and Lap Band special pricing....time is running out so ACT NOW!!

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.