Total Body Surgical Blog

As surgeons that wear many different hats during the week (Cosmetic Surgery, Reconstructive Surgery, Bariatric Surgery, and General Surgery), Dr. Swetnam and I are faced with constant challenges; and it is a significant challenge to keep everyone satisfied.  As one of my favorite subjects, today I'll discuss post weight loss cosmetic surgery.

Typically, bariatric surgery patients first and foremost have decided to take the plunge in changing their lives.   I heard it best this week from a patient who told me, "Dr. Miller, I am sick and tired of being sick and tired." It's a lifetime of habits that they must break: the way they eat, the way they exercise, even just the way they think. The positive repercussions of weight loss are legion.  It truly is an entire lifestyle change.  It is amazing for me to see how one positive change by a bariatric patient effects those around them.  I recently saw a patient that was 12 weeks out from a sleeve gastrectomy.

To both of our satisfaction, he had already lost 70 pounds.  On top of that, his wife had also lost 30 pounds just by following the same diet that I'd ask him to impart postoperatively.  The little cherry on top of all this icing post surgery was that their daughter had also decided to begin to make healthy food choices, resulting in weight loss as well.  It's amazing how one positive decision begets another positive decision.  Unfortunately, one of the few anticipated post weight loss "problems" (besides having to purchase a new "skinny" wardrobe), is what to do with all the extra skin that sometimes results from losing excess weight...? The thing is, not everyone ends up with excess skin.  Really, it depends on multiple factors: the patient's age (no, I didn't just call you old); how many children a patient may have had; excess roller coaster weight loss and gain over the year; and the personal skin elasticity of a patient.  The latter really making the majority of the difference.  Quite honestly, it really comes down to how you picked your parents when it comes to skin elasticity.  Genetics is key to just about everything under the sun, and skin elasticity certainly falls into that category.  So why does this matter? Think of it this way: if you have a 10 pound sack of potatoes and take out 9 pounds of those potatoes, you've got a lot of sack left over, right?  Sometimes this sack shrinks down, and other times it does not.  Again, all as a result (or lack thereof) of the degree of skin elasticity someone may or may not have.   I am often asked if exercise will help to tighten up the skin. Unfortunately, I can assure you that all the situps and jogging in the world will not help that excess skin to shrink.  So, what is the answer then?  What do I do now that I've lost this weight and my skin gets rashes between the folds?  And sure, I've lost a significant amount of weight, but my clothes still don't fit right lugging this extra skin around!  This is where the post weight loss recontouring comes into play. 

     Though not every post weight loss patient needs them, there are multiple  body contouring options for those that do post weight loss: tummy tucks, liposuction, arm lifts, breast lifts, thigh lifts, and body lifts. Typically, one or a combination of these procedures have been successfully used after weight loss surgery to refine patients’ bodies, and help them enjoy everyday activities as they envisioned at the beginning of their journey.  The most common procedure that Dr. swetnam and I do is the tummy tuck.  Essentially, that entails not just removing the excess skin present, but also tightening up the actual abdominal muscles.  We basically create an internal corset that results in a waist that many people had not seen for many, many years.  Following the tummy tuck, I would say that breast lifts are our next most common procedure post weight loss.  It's amazing to see how people's attitudes change as they continue along their weight loss journey.  Specifically, people who had become shy wall flowers virtually become alive again. Their inner personality that had been stifled for so long is reawakened.  No longer just satisfied to wear bulky sweaters and oversized tshirts to hide their insecurities, they sometimes pursue breast lifts.  Breasts that were once being tucked into their front pockets are now perky and full on the top of their chest- right where they should be.  Following breast lifts, arm lifts (sometimes termed brachioplasty in doctor-ese) would be the next most common procedure that Dr. swetnam and I perform.  It is essentially just removing extra skin and remaining fat to create a nicely contoured arm again.  Thigh lifts are much like arm lifts, except just a bit further south.  I would say that thighs are the most challenging to operate on, as God didn't create us in anticipation of having incisions in our groins (location required to lift up those thighs again).  I should mention here that the great thing about having two fellowship trained cosmetic surgeons together in a group means that more procedures can be done at the same time.  Why does that make any difference? First and foremeost, the operative time is more than halved.  This is not just better for the patient's health, but also is more cost friendly for the patient in the long run. 

     So when should a post weight loss patient consider having body contouring procedures done?  Typically, I suggest that a patient be within 80% of their weight loss goal.  Typically, this is at sometime between 12 and 18 months.  As I said, body contouring is not something that is essential from a health perspective, but rather as the end result of a long journey.  It's basically seeing the final end point result come to fruition.  It has been said more than once that we are flattered to be a part of this whole process, both as the wearing the weight loss surgeon's hat, as well as that of  the body recontouring surgeon's.  We literally know our patients inside and out!   

Come see us today for your complimentary Cosmetic consultation!!  918-786-7780 or 1-877-weight-0. 

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.

  If you have not looked at this offer in the red box....you may be missing out on the opportunity of a lifetime!

What does skin cancer have to do with you?  Quite a bit actually.  Skin cancers are the most common cancers and that is when compared to ALL other cancers.  There are 3.5 million skin cancers diagnosed each year and another 77,000 cases of melanoma.  The incidence of all types of skin cancer are on the rise for an unknown reason.  One can speculate however, i.e., tanning beds, less coverage of skin with modern fashion, changes in our atmosphere, etc., etc.  But nobody really knows why.

As you can see from this graphic, this is a common problem.  Of course, there are several types of skin cancer that are common.  There are types that are not as common.  Then there are very rare types that are beyond the scope of this discussion.

Let's talk about the most common types first.  Basal cell carcinoma's are the most common types of skin cancer.  As the name suggests, this type of tumor arises from the basal layer of skin and is associated with UV or sun exposure.  This type of skin cancer comprises about 2.8 million of the 3.5 million skin cancers occurring in 2012.  These tumors very rarely spread to lymph nodes or other organ systems.  They start off small...

 are often ulcerated with raised edges.  Like a sore that never goes away.  They usually only spread locally and can become quite large if left alone...

  They can locally invade through bone and can require extensive surgery to remove.  It is therefore wise to seek advice while these lesions are small and easily removed.  We usually remove them surgically but they can also be removed by a Moh's procedure.  After complete removal the tumors rarely come back unless there are multiple areas involved (multi-focal tumors).  Also, the sun damage that caused the original tumor is also present on other exposed areas.  Therefore, once one is removed you must be diligent to identify and remove other tumors.

The second most common tumor, accounting for about 700,000 cases, is squamous cell carcinoma.  These tumors arise from the superficial layer of the skin and are also associated with sun exposure.  Squamous cell carcinomas involve the most superficial layer of skin.  They are usually scaley, thinner tumors in sun exposed areas.  Unlike basal cell cancers, these tumors can spread to lymph nodes in about 2-3% of cases.   This is why removal of these tumors early is a good thing. 

The big daddy of skin tumors is the melanoma.  It arises from the pigment cell in the skin called the melanocyte.  These tumors can be nasty.  About 70,000 of these tumors were diagnosed in the U.S. last year and it seems that it is on the rise.  Melanoma can spread about anywhere.  From the brain to the eye, spread of the disease is a tough problem.  These tumors can occur any place in the body that has pigment cells.This picture is pretty classic for a nodular type melanoma, irregular, varied color, and a nodule.  They can, however, look like a normal mole.  Any pigmented lesion on the skin should be watched for change or increase in size.  Treating melanoma early is critical to survival and recovery.  Early treatment means less chance of spread to other places.

There you have it, a quick primer on common skin cancers you need to look out for.  Come see us for these problems and we can help.

918-786-7780 or 1-800-weight-o.

  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.

Last week we talked about treatment of facial redness, facial veins, and rosacea as a cause.  Most of these treatments involve some type of light therapy or laser treatments.  The laser is used to close visible veins on the face and at the base of the nose.  It works by damaging the lining of the vein, it ceases to function, and your body eventually gets rid of it.  Of course, some new veins may appear with time and may require further treatment. 

 just a reminder..

For the redness associated with aging and, or rosacea, we use IPL (intense pulsed light).  The intensity of the pulse of light also targets the red pigment in the smaller capillaries of the skin of the face, causing them to close.  After a short time, the redness is much less.  In many cases, we will use the laser and IPL at the same time, closing the larger, visible veins with the laser and the generalized redness with IPL.  The IPL treatments also can target "age" spots on the face, or areas of Melasma (mask of pregnancy or pigmented areas).

 melasma   age spots

These areas are caused by Ultraviolet light (sun) exposure and hormonal changes.  This is why we recommend not tanning your face!!!, or use sun screen on your face and re-apply often.

OK, after this reminder of what we are trying to address with the laser...what is, and why do you need "pre-treatment"?  First of all, we want the treatments to be as effective as possible.  If you pre-treat the skin, the dead layer or stratum corneum is not as thick and the light used penetrates better.  This, of course, gives a better result.  The other problems that can occur with light therapy are:

-hyperpigmentation:  in other words, the skin cells that produce the pigment in the first place can respond by making more....not what we're looking for.

-hypopigmentation:  loss of skin color.  The pigment cell stop working and the skin becomes too light.

-persistant redness:  redness of the skin after treatment that can hang on for months.

Of course the percentage of people that have any one of the three of these happen is very low, however, we want to decrease the risk as much as possible.  How do we do this?....by pre-treating the skin of course.

What we, and most others, use is a combination of a retinol compound, and a fading agent.  Retinol compounds are derivatives of vitamin A.  (retinol, retin-a, tretinoin, etc.)  There are chemical differences between them, but the end result is to compact or thin the outer, dead layer of skin and stimulate the live, basal layer to turn over quicker and thicken.  They also retard the degradation of collagen and slow down the darker pigment cells that create dark spots.  All retinols will also dry the skin to some extent and decrease oil production.  These effects are great for acne and for some forms of rosacea.  The other product we use is a hydroquinone.  Hydroquinone works by inhibiting an enzyme in the melanocyte (the cell in the skin that produces pigment) that is critical in forming the melanin or dark pigment.  By stopping this pigment production before any light treatment, we can decrease the likelihood of hyperpigmentation as a problem.  The continued use, after laser or light therapy, of hydroquinone keeps the age spots and, or melasma from returning.

Of course, pre-treatment does not guarantee that any one, or all, of the problems that can occur will be prevented.  But pre-treatment does greatly lower the chances.  The darker the skin, i.e., ethinic skin, the greater the chance of problems with or without treatment.

At Total Body Surgical, we use the Obagi line of skin care products for pre-treatment and maintenance.  It is medical grade (prescription grade) and works very well even if laser or light therapy is not used.  Our pricing is great and we start people on the travel size products so they don't buy large amounts to start with.  If your skin cannot tolerate it, (very unusual) or if you don't like it, you have not made a huge investment.

So come see us for facial pigment issues, rosacea, or acne.  We have the experience and equipment to help you.  Cosmetic consultations are complimentary so 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.

Possibly more changes on the horizon for weight loss surgery are in the making.   

These changes will have an effect on the entire landscape of bariatric surgery in the U.S.  First, a little history....

When bariatric surgery first started (weight loss surgery) there were few regulations and a multitude of procedures that were tried.  All procedures were done through a large incision and most of the patients are high risk due to their weight and many other additional medical problems brought on by the weight, i.e., diabetes, high blood pressure, heart disease, sleep apnea, etc.  This combination led to a high complication rate and high mortality.  What has changed in the past several decades to make these procedures much safer is the innovation of laparoscopy.  This allows us to do the procedure with tiny incisions, fewer wound problems, much less pain, and shorter hospital stays.  Other changes that have happened are the standards that were set for bariatric centers. These standards were fairly rigid and the procedures done were made more standard.  What we have learned is the bariatric patient needs a higher level of pre-operative evaluation and post-operative care than the average patient.  Because of this, the American Society for Bariatric Surgery was formed and guidelines were created to improve safety and "centers of excellence" were created.  Centers of excellence were formed based on criteria set for pre and post op care, and a minimum number of cases done in a year. 

After gaining experience and analyzing a ton of data, it was discovered that the center of excellence really does not change outcomes.  What this means is you can have a procedure done at a center of excellence or a non-accredited center and have just as good an outcome.  The net effect of the center of excellence has been to limit access for medicare and medicaid patients with no real benefit.

After joining forces, the American College of Surgeons and the American Society for Bariatric Surgery are trying to change (in my opinion for the better) the center of excellence guidelines.  Here is what the proposed changes will look like:

1. Three divisions will be set up, the first being band centers, where only lap bands will be performed.

The Gastric Band on the stomach.

The second division will be "low acuity" centers of excellence.  These are smaller facilities "like INTEGRIS Grove hospital" that have qualified surgeons but limited ancillary services.  These centers will be able to do staple procedures on "lighter" individuals with few other medical problems. In other words, healthier, lighter patients will be able to have their procedure done on a more local basis and not have to travel to big centers.

Sleeve gastrectomy                                               Gastric bypass

In these lower acuity centers, the work up is the same and all of the patients are tracked by a National Data base.

The third division is the high acuity center.  This is where heavier and more complicated patients will have to go, usually in the larger regional hospitals.

This is the proposal that was sent to the CMS (Medicare).  However, they have different ideas about the whole thing.  CMS, looking at the data, thinks that possibly communities would be better served if the whole center of excellence thing was just eliminated.  They do have a substantial amount of data that shows there is no improvement in outcomes.  Now the Politics come in.  What politics?  Well, current centers of excellence don't want any change and centers that want to gain this distinction can't because the number of cases that must be performed, under the current rules, cannot be reached.  The number of people needing the surgery continues to grow and many cannot get to a current center of excellence for care.  My feeling is that if you have a qualified surgeon and a program in place....what difference does it make.  People that need the surgery should not have to travel hundreds of miles, and according to the data, it makes no difference.  Hopefully, a reasonable compromise will prevail....and soon.  Many programs, ours included, are sitting on go, waiting for some sort of direction.  In the mean time, we are limited to private pay patients and private insurance patients currently.  We are looking for some type of decision in 2014 and are hoping for good things.

   Of course the changes will mostly only effect Medicare and Medicaid patients but some private insurance as well.

So that is what's on the horizon...better access.  We hope to be a low acuity center in the very near future as Dr Miller is fellowship trained, certainly qualified, and ready to go!

Our cash prices are pretty good too (see below) and you don't need to travel to Mexico either!!

So come see us today!!  Cosmetic consultations are always complimentary!! The spring laser liposuction special is going on so act now to reserve your time!  918-786-7780 or 1-866-weight0.  And don't forget our low prices on breast augmentation either!!!

Keep an eye out for the news reports on the sleeve gastrectomy!!!

Now that the breast special is over (just so you know, our usual price for saline implants is still the rock bottom price of $3800!) we're going to wear out the liposuction for a while. 

"Lunch time" liposuction.....what the heck is that?  Most people see liposuction as a very violent and traumatic experience, right?  Here is a brief history of liposuction compliments of liposuction.com:

Liposuction has become one of the most commonly performed cosmetic surgeries in the United States. In 1974, Dr. Giorgio Fischer, a gynecologist from Italy invented the original form of liposuction. French physicians Illouz and Fournier further developed liposuction around 1978. By 1980, liposuction was extremely popular in the United States but was confronting negative publicity due to patients experiencing excessive bleeding and undesirable rippling of the skin after surgery.

In 1985, Dr. Jeffrey A. Klein, a California Dermatologist, invented the tumescent technique for liposuction, revolutionizing liposuction surgery. His “Tumescent Technique” allowed patients to have liposuction performed totally by local anesthesia using much smaller cannulas. Patients could now have liposuction surgery without the fear of excessive bleeding and undesirable skin depressions.

Here you can see the tumescent fluid (numbing medicine, saline or salt water, and a vasoconstrictor) being injected into the fat layer.  This provides anesthesia for the area and helps to minimize bleeding.  Of course, there is a limit to how much lidocaine we can use based on the patients weight and this limits the number of areas we can do at any given time.  Even though larger areas can be done, we do them all the time, smaller areas are perfect for this technique.

We also use some sedation when doing larger areas to limit the amount of discomfort while the fluid is being injected.  We then allow some time to pass so the fluid has time to work.  Once the local anesthetic takes hold, we start the procedure.  For most cases, we use the Cool Touch laser to break up the fatty tissue and warm the skin. 

Warming the skin promotes new collagen formation, causing the skin to contract to its new position and tightening it.

We then use hollow cannulas to remove the liquified and non liquified fatty tissue. 

This is a picture of a selection of cannulas in different sizes or diameters.  The fat is suctioned out of the body, into a cannister, and discarded. 

Once the fat is removed, it takes a few weeks for the swelling to go down and a few months for the skin to contract to its new position. 

How painful is it??  This is everyones fear of course.  For small areas, the discomfort is minimal, usually only putting in the tumescent fluid causes a minor amount.  For larger areas there is some pinching around the edges usually and this is why we use sedation.  People walk in and walk out, usually going home to rest after.  After treatment of small areas, most people can return to work the next day and for larger areas, patients return to work after a few days or a week at most.  You will be sore (like you did a very vigorous workout) for a few weeks and of course, the more you move around, the shorter the sore period is. 

What you do after consists of a few things....first, exercise.  Opinions differ but I like for patients to start stretching and massage after a week or so and resume normal exercise after about 3 weeks.  Personally, I like for patients to wear a "spanks" for a month or so after large area liposuction.

I think it really decreases discomfort and bruising.  Most people complain of an itching feeling on the skin over the treated areas as the nerves recover.  My feeling is that the compression helps this sensation as well.

That's all for this week!  Make sure you look at our liposuction offer...it is really a good one.  If you have saddle bags, fluffy inner thighs, or any other area you simply cannot get rid of, give us a call today to schedule your complimentary consultation.  Our pricing is the best. 

918-786-7780 or 1-866-weight0

That is the question we hear daily.  Do I NEED a breast lift??  With this being one of the last installments on breast for a while, I thought a little knowledge in this area would be helpful. 

Before we start, let me remind you that we have 20 days left on the spring time breast augmentation special pricing....click below to see how you can get breast augmentation surgery, ALL INCLUSIVE, for as little as $3500.00!!

Now for the burning question...do I need a breast lift??  The answer to that question is, in some cases, a little fuzzy.  There are instances where the decision is easy.  If you have no breast tissue, or very little, and the nipple position is high, obviously, you do not need anything to enhance the breast except volume, i.e. implants. 

 In this picture, the nipple position is great, the skin is tight, and only an implant is necessary.  After implant placement, the skin will stretch to accomidate the implant and the breast will take on a nice and natural shape.  This is the perfect patient for implants alone.  As discussed in earlier blogs, the incision placement options, size, and type of implants are variable according to taste. At your consult, all of this will be discussed and you can decide.

The second presentation that is fairly easy is the patient that has significant drop in the nipple position

If the nipple has fallen below the fold under the breast (inframammary fold) then a lift is always needed.  Some select an implant and some do not.  That is a personal choice, but if fullness is desired in the upper chest, it is difficult to create, and maintain, without an implant.

This picture depicts one of the "easy" decisions.  Obvious drooping of the breast and nipple complex below the lower fold of the breast where it attaches to the chest.  If we were to just place an implant in this situation, there would be a nice implant present with a sagging breast hanging off with the nipple still pointing at the floor.  Several procedures are used to lift the breast.  We usually use the Weiss pattern lift (anchor incision) for larger lifts and the vertical (lolly pop) lift.  Both types of lift raise the nipple into a more normal position, remove excess skin below the breast and move remaining breast tissue into a higher position.  In the picture above, we call this the "rocks in socks" breast.  There is some breast tissue hanging around the nipple (rocks), and skin (socks).  If lifted only, this will be a very small and flat breast.  This is when an implant can really be beneficial to give the breast some volume.  Others have a sagging nipple and breast but still have a good amount of volume.  A lift alone, or with implants are both choices.

This is a photo of a breast lift alone. The shape is nice and nipple position is good, however, the upper pole remains flat.  This can only be fixed, long term, with an implant.  Implants, however, can be placed after a lift so you can decide later if you want them or not.

As you can see, a lift with an augmentation can be done simultaneously with good results.  This gives good fullness to the upper pole of the breast with the added benefit of only one procedure.

Now for the harder ones.  Many women have breasts that have fallen some but not to the extent we have discussed.  When the nipple is just above the lower breast fold or even with it...now what??  When the nipple is above the fold but there is significant breast tissue below, this is called pseudo-ptosis or false droop.  We have more than one option at this point.  One is to put large implants above the muscle, preferably silicone.  This is actually not a bad option for the right person.  The breast will still remain a little low, not filling the upper pole as much as if a lift were also done. Also, need for a lift later is still a real possibility. This is good for those who do not want scars on the breast and are willing to accept a breast that is not quite as "perky".  The other option for this group is to go ahead and bite the bullet and do the lift with or without implants.  This will generally fix the problem long term, give you a nice fullness to the upper breast and move the nipple into a more normal position.

Breast pseudoptosis with implants.  Looks pretty good, but upper pole is somewhat flat.  If this is acceptable, it is a great choice.

Well that about does it for this week.  I will try to move on to something else next time.  Remember our breast special pricing and call today....918-786-7780 or 1-866-weight0.  Cosmetic consults are complimentary!!

I started working in the yard last weekend.  It was warm and sunny.  While I worked, I noticed that the trees are budding out, and there were even a few with some juvenile leaves showing up...guess what...the warm days of summer are nearly here!!  While we talk about hair and skin, don't forget about our breast augmention special, hit the button below to get the details.

This week I wanted to cover a couple of old subjects...skin and hair.  With summer rapidly approaching, these are two of the things that you can improve quickly and get ready for summer.  So what can you do??

1.  Hair.  Most women (and some men) don't like hair in certain places.  This includes the bikini area, underarms, face, and legs in women, and chest, back, and underarms in men.  What can we do about this?  Have you ever shaved in any of these sensative areas and wished you didn't have to? Or, at the pool, notice that you SHOULD have?  That hair is hard to tuck in!!  What about getting waxed, and with tears in your eyes, thinking, there has got to be a better way than this to get rid of this hair!!  At Total Body Surgical we can rid you of this problem for the rest of your life....AND....with unbeatable pricing, not break the bank.

We use the Cutera system to do our laser hair removal.  It is one of the few systems that is FDA approved to treat all skin types and it is very effective.  We expect to get rid of 80-90% of the hair completely and what is left is spindly, light, and weak if there is anything.  Of course the hair has to be darker for us to treat it because that is how the laser works...the dark hair transmits the light energy as heat into the follicle, killing the hair stem cells.

As the population of these cells decreases, the hair becomes thinner and thinner until eventually, it is gone. Body hair generally takes about 6 treatments and facial hair, because it is thinner and transmits less energy, about 9 treatments.  The darker and coarser the hair, the quicker it goes.  The treatments are spaced about 6 weeks apart and generally take about 30-40 minutes.  We use numbing cream and let it set about 20 to 30 minutes before the treatment.  If you do not want to numb it takes less time of course.  Everyone is different so some like the numbing and some don't.  We use the Zimmer cooling system so the discomfort is minimal even if you don't numb.

Remember, hair has to be there for the laser to work.  This means you must wait six weeks after waxing or using a cream hair remover.  You can trim or shave the areas being treated so it does not have to be long and embarrassing.

The way we do areas is like this....the face is considered an area, the underarms is considered an area, the bikini is considered an area.  The legs are considered 4 areas due to the large size so lower leg front and back is 2 areas, thigh front and back is 2 areas.  The abdomen upper and lower is 2 areas and the chest, upper and lower, is 2 areas.  The back, upper and lower is condered 4 areas as well, divided as the abdomen and chest are.

Be sure to click on the hair removal button above to see how affordable hair removal really is!

2.  Skin.  Most skin issues, i.e., pigment changes, are due to UV (sun or tanning bed) exposure.  In women, hormonal changes also contribute.  These changes have many names....

melasma 

poikiloderma 

Of course, they occur on the sun exposed areas of the face, chest, neck, and arms.  If you have these areas, they will usually NOT resolve by doing nothing.  What do we advise??  First, sun protection.  No matter what we do, if sun exposure continues, these areas will return.  Sun screens, hats, and cover ups are critical to the success of any therapy and once you have that covered, we can start addressing the problem.  Basic skin care is critical and the product we recommend is Obagi.  Created by a Dermatologist the line is medical grade and is VERY imitated.  It contains medical concentrations of tretinoin and a lightner.  The kit we recommend also contains the products to manage the pH of the skin, making the medicines work better.  Compared to other products, it is very affordable.  After a few months you will see the skin looking healthier and the discolorations decreasing.  For faster results, or for areas that are a problem, we use Pulsed light treatments.  These treatments target areas of pigment and cause them to peel off quicker and also help turn off the cells that are creating the pigment.  It usually takes a series of treatments along with the basic skin care.  I feel like the best sun screens come from the Skinceutical line of products.  They were also created by Dermatologists and come in many strengths and even in a water proof formula. 

So, get your skin in shape for the coming summer, AND, get rid of your razor!!

Call today to book your treatment or consult 1-877weight0 or 918-786-7780.  There are about 40 days left in our breast augmentation spring special so don't delay...ACT NOW!!