Total Body Surgical Blog

Many questions exist about liposuction.  Most people have an image of a very violent and bloody procedure with results that are less than optimal.  Todays liposuction is much different.  Due to techniques we use today, liposuction can be done in the office, with only sedation.  I would like to address a number of questions that are commonly asked of me during a consult, and many points that I like to talk about with patients to help them understand what they are to expect. 

First, will I get fat in other areas after liposuction?  This is one of the more common questions I am asked.  The theory is that we are all born with a finite number of fat cells.  As we gain or lose weight, we do not gain or lose these cells, they just grow or shrink in size.  Some data show that in the super obese, cell numbers may actually increase but we don't liposuction these people.  During liposuction, we remove fat cells in the area we are treating.  Therefore, if someone gains weight after liposuction, it will accumulate in other areas since we have removed the fat cells in the area they have gained in before.  This is true, however, to make a significant difference, it has to be a significant amount of weight....20-30 lb.  Most people that spend the money on this type of procedure are not going to let this happen.

Second, will I get lumpy in the area of liposuction?  This can happen, especially after weight gain.  If you think about the procedure, we are removing layers of fat...not all of the fat.  Some remains.  This is a good thing.  Leaving a layer of fat below the skin allows the skin to remain smooth and supple.  Oversuction can create dents and allow the skin to scar to connective tissue underneath....both bad things.  With some live fat remaining, if you gain weight, these pockets of fat cells will increase in size and can form areas of lumpiness.  Lumps in the immediate period after liposuction are a normal thing.  Usually they are a little sore and represent areas where fat has been damaged and the body is breaking them down.  I like for people to massage these areas to speed up the process.  It can take several weeks to months for them to completely resolve.

Third, will my skin be saggy after the procedure.  This is the thing that is hardest to predict.  The things I look for are the ones that indicate skin quality before the procedure.  For example:  The stretch marks in this photo would indicate to me that a tummy tuck would be a better choice for her...why?  Her skin will have less of a chance of contracting after the fat is removed because of the poor starting skin quality.  It will be more likely than not that her skin will not contract.  This does not rule out liposuction for her but she must understand that, in clothes, she will look better and more sculpted, but in a swimming suit, the skin will still look bad and possibly more saggy.  If her skin were smooth, she would be a much better candidate.

Fourth, will the newer technologies help the final result?  Yes and no is the answer.  Laser and ultrasound technology have helped but they are not the silver bullet.  I like to use them as an adjunct to traditional liposuction.  The idea is that heating the skin from the inside does cause some contraction, how much is the unknown.  I remove the fat first then use the laser to heat the skin to allow skin contraction.  Several studies have been done that indicate the use of these technologies alone are sub-optimal and my experience verifies this.

We do liposuction often and combine it with many procedures.  It is a great procedure and helps a lot of people.  We do the procedure in the office with sedation and tumescent solution.  This solution contains lidocaine that numbs the area and also epinephrine that causes the small blood vessels to contract and limits blood loss.  Patients recover quickly and this depends on the size of the treatment area.  It takes the skin several months to contract and heal so the final result is seen after 3-4 months.

Come see us for a consult and for a limited time receive 10% off of the procedure.  Don't forget our laser and breast offers too!!!!

918-786-7780

Laser days at Total Body Surgical!!!!  We know have the Cutera laser full time in Grove...VERY exciting.  The Cutera laser is one of the most comprehensive lasers, IPL combinations on the market.  The system can nearly do it all, and do it well.  I have many years of experience using this system and it is great at treating a large number of problems.  Let's itemize them:

1.  Laser hair removal.  With the Cutera system we use the ProWave 770.  It is an IPL (intense pulsed light) that can treat large areas and do it very effectively.  In a pinch for smaller areas that are difficult, we have the 1064 YAG which most of the older systems are based on.  Laser hair removal is very popular and has, in the past, been cost prohibitive.  For a limited time, we are offering an exceptional deal...$50.00 per area per treatment.  This will be good through the summer so don't miss it.  Usually facial hair takes about 9 treatments and body hair 6.  This means you can get your underarms done for $300.00.  Take advantage of a great value!

2.  Facial or body dyschromias.  Age spots and redness become a problem as our skin ages.  The IPL Limelight system is great for treating a variety of discolorations on the face, arms, and hands.  This usually requires a series of 3-5 treatments and we usually like to have you on the Obagi skin care system to prevent further damage or recurrence.

3.  Facial veins.  We use the 1064 YAG to treat small viens that occur at the base of the nose, on the cheeks and chin.  The laser targets the pigment and closes the vein, removing it on a permanent basis. 

4.  Leg veins.  We use the 1064 YAG to treat small areas of leg spider veins as well.  For larger areas we usually inject with a sclerosant.

5.  Laser skin resurfacing.  We have the Pearl laser for resurfacing.  This helps with reducing pore size, improving skin color, fine lines, and wrinkles.  The great thing about the pearl is the short recovery time and similar results to the CO2 laser.  Recovery times are about 4 days with great results.  Some may require a series of 2-3 treatments about 2 months apart.

6.  Laser treatment of Hemangiomas or cherry spots on the body or face.  These require only one treatment in most cases and they are eradicated.

7.  Laser Genesis for treatment of acne, to reduce pore size and improve skin tone and texture.  This works exceptionally well with no down time.

8.  Titan treatments for skin laxity in the neck and face using Radio Frequency with no down time.

We are very proud to have such great technology in Grove.  Our pricing is unbeatable and results are outstanding.  Our nurses, Janet and Trish are very skilled at suggestions and advice and are very good at treatments.  We also have the Zimmer system that provides comfort during treatment sessions.  

Come see us soon to arrange YOUR treatment plan and schedule.  Call 918-786-7780 to arrange today.

Breast disease for men???  What the heck you say.  Well, it does happen even though breast problems and Cosmetic breast surgery IS much more common for women. What kind of problems would a guy have is a question you might ask.  Well, there are several, but today I want to address a problem called gynecomastia.  Gynecomastia is a word that means puffy nipples.  Gynecomastia normally occurs during hormonal changes in the life of infants, adolescents, and men.  The first time in life it occurs is in infancy.  After birth, estrogen from the mother is high in the infant and breast tissue develops that rapidly disappears.  It also occurs in elderly males as the hormonal changes of aging take hold.  Many medications can also cause the breast tissue to increase.  Other causes are beyond the scope of this installment.  I mostly want to focus on the adolescent occurrence.  In adolescent males, gynecomastia can develop in as high as 80% of individuals.  Again, its the hormones that occur normally and in those who use anabolic steroids.  Unfortunately, in up to 30%, it doesn't go away this time.  Gynecomastia during adolescence is made of fatty tissue with a bud of breast tissue under the nipple.  By the early 20's it should be gone, if not, it may become a real problem.  The problems it causes are not generally physical but psychological.  Wearing normal clothing becomes an uncomfortable situation for a guy that has breast tissue and makes one very self conscious.  Working out to develop pectoral muscles can often times only make things worse...so what's a guy to do??  First of all, be patient.  It is hard to do but fortunately, in a majority of cases the problem resolves after hormone changes settle down.  In cases that don't resolve, we can take care of the problem.  Usually, in the normal case, I will liposuction the chest and remove the "bud" of breast tissue.  I do this through a small incision in the arm pit to liposuction the chest of excess fatty tissue.  I then make an incision through the nipple to remove the small bud of breast tissue.  We do this in the office procedure room using some IV sedation and tumescent local.  It takes less than an hour and can be life changing.  We have you wear a compression shirt for about 3 weeks and from that point on, normal clothes can be worn without the worry of those two little reminders poking through.  The incisions heal very well and go unnoticed after a healing time of a few months.

If you or someone you know has this problem, come see us!  We can help.  Call 918-786-7780 for an appointment.  Don't forget our other specials as well...laser hair removal, breast augmentation, nail fungus eradication, and great pricing on Obagi skin care products.

Today I am going to give you a test.  Fun, huh!!  No grades will be given, thank you.  Hopefully you can learn something from this and if you like it, let me know here and I will come up with some similar ones for other common procedures.

Today the test is going to be about liposuction and tummy tucks....when is one appropriate and not the other and vice versa. Good luck!!

#1.  ....what do you think??  Tummy tuck or lipo?

  We start with an easy one.  If you said tummy tuck, you would be right.  There is no doubt there is a lot of fatty tissue present and liposuction COULD be considered, however, the hanging skin would only become worse.  A tummy tuck with associated liposuction of the waist would be the appropriate choice.  The tummy tuck would remove the excess skin and stretch marks below the belly button and liposuction of the waist would accent and renew the shape of the sides of the abdomen.

#2.  Which is it, tummy tuck or liposuction?

  This one is a little tougher.  When you look at this abdomen what do you see?  As far as fatty tissue goes, there is only a problem area in the mid abdomen and a lower abdominal pooch.  Normally, this would be a perfect abdomen for liposuction, however, you always must evaluate the skin quality too.  The skin in the lower abdomen is riddled with stretch marks.  For this reason, I would recommend a tummy tuck.  The tummy tuck removes a majority of the stretch marks, tightens the remaining ones and moves them below the pant and swim suit line.  Of course if she presented not caring about skin quality after the procedure, a liposuction procedure could be selected.  I would doubt the level of satisfaction after liposuction alone.

#3.  Which one??

  Not exactly a clinical photo, but, it makes a point.  This girl is the perfect example for liposuction.  Perfect skin, nice shape overall, and just a small area of fat in the lower and mid abdomen....what a pallet!!  I could make this abdomen look amazing.  I would use a small cannula, remove the fatty tissue and give her some definition.  I would then use the cool touch laser to tighten the skin more.  It would look fantastic.

#4.  The last one...Tummy tuck or lipo....this one is a little tough so take your time!

  This abdomen is a little tougher.  The skin looks pretty good.  The shape is fair with some fatty pockets that could easily be removed with liposuction.  Liposuctioning the waist would also improve her shape into a more hourglass look.  BUT, what about the C-section scar?  It is a point of adherence that liposuction will not address.  I would recommend a mini tummy tuck with liposuction.  This would allow me to tighten the lower abdominal skin, remove the C-section scar, and liposuction the waist.  I would not make an incision around the belly button but remove some skin that will make it look better.

Good job!  I hope you enjoyed our little quiz.  Remember to let me know on facebook, twitter @jeffswetnam, or here if you like it.  I can come up with some more I think you will like.

Here are a couple of pictures of my work....

Don't forget our laser hair removal special...$50.00/treatment/area...amazing.  Also, our breast augmentation special for silicone and saline.  Lap band specials as well.

Welcome to Trish, our new RN.  An amazing girl that we are very proud to add to our Total Body Surgical Staff.

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!!

                                                                                      Let's talk about eyelids for a bit.  As the old Yiddish proberb says, "the eyes are the mirror of the soul"....eyes are very important.  When we meet someone, where is the first place most people look??? the eyes.  Therefore, if we have prematurely aging eyes, they can make us look older, more tired, and cover one of the most beautiful attributes we all have.  Eyelids, though small, can change even the way we think about ourselves.  We look in the mirror and even though we don't feel tired because of the "tiredness" we see in our eyes we begin to reflect it in our actions.

Youthful eyes are wide and inviting.  The upper lid is full with few wrinkles and no excess skin present.  The lower lids are smooth with skin color that is pink.  There are no bulges, folds, or "bags" to draw our attention from the color of the iris or the pupil.  We see well as there is no abstructing skin in the way.  We look and feel great.

As the instoppable aging proces happens, eyes, are at times, the first thing to reflect it.

  Why is this?  When did it happen?  How did the first picture become the second??  Well, let's get some answers.  The eyelid skin is some of the thinnest skin on the body.  It also moves more than the other skin and it is constantly exposed to the damaging UV rays of the sun.  The other thing that happens is a loss of fatty tissue in the face.  This exposes underlying connective tissue where it is tethered to bone.  Lines and bulges that are normally window shaded by ample fat pads begin showing up when those fat pads diminish.  Fine lines and wrinkles develope from sun damaged skin, motion, and sagging of the muscle around the eye.  The process is unrelenting and over time, the sagging skin can even decrease vision.

  What we see here is a large amount of extra skin on the upper lid obstructing vision and the fat pad below the eye is protruding with severe skin changes.  Regardless of actual age, these changes can create the image of a very old person and the view of the eye is just a slit...not a very good view of the soul.

At Total body surgical we do a lot of eye rejuvenation.  It is one of the more rejuvenating procedures we do.  It is fairly simple and can take years off.  Upper lids are done with some light sedation and local anesthesia.  Lower lids can also be done with light sedation sculpturing the fat pad and either removing the loose skin or lasering it to tighten it up.  We often graft fat into the cheek to restore a more youthful look.  Recovery time for upper lids alone is quick, usually about a week and for lower lids a week or two depending on laser use.  We have great pricing on lids so be sure to check us out!  Cosmetic consultations are complimentary so call 918-786-7780 for a visit.  Also remember our other offers on the lap band, breast augmentation, hair removal, and liposuction.  Summer is right around the corner, so get ready now!!!

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.

Now is the time!!!  Time for what you ask??  Time to get a jump on summer!

There is a lot that can be done to get ready for a new look this summer.  Probably the biggest thing (no pun intended) is a breast augmentation.  Many women think about doing this when summer is already here.  Then, it is too late in many cases to enjoy them.  It does take a few weeks to recover and regain normal activity.  So in reality, now is the time.  Do it in the winter, recover in the winter, and unveil in the spring and summer.  Spending time at the pool or lake in your new suit with new assets will be great fun for you after an augmentation. 

Whether you want saline implants or silicone gel implants, we, at Total Body Surgical can take care of your needs.  We are here to please.  I will personally listen to your desires, we will discuss the pros and cons of different implants, placement options, and especially sizes.  Most women are worried that I will choose the size and you will be stuck with it.  At our facility I will give you a range of sizes based on your measurements and we will try them on in your clothes and YOU decide so you can get the look you want.  Our special pricing for this summer is $3899.00 for saline implants and $5099.00 for silicone implants.  This includes all fees with the exception of medications that you will get from the pharmacy.  It includes the pre op and all post op care. 

The other big thing we have discussed recently that can make a huge difference is liposuction.  Many women have small areas (hips, thighs, saddle bags) that are unsightly.  These areas are difficult to get rid of even is you are in great shape and exercise regularly.  This is when liposuction shines!  For small areas we can do them in the office with or without sedation and it is very affordable.  Recovery time for a single small area is very short (a weekend or so) and when using the laser the skin contracts well over the next few weeks and looks great.

Our pricing for liposuction is fantastic and we have bookings available now.  As summer approaches, spring break, etc. get closer, the operating times get tight. 

Come now and get these special prices and book your time before it is gone!!

Don't forget our amazing hair removal offer as well!  Just $50. per treatment (an average of $300 per area).

"Hairless summer".....do you want one??  No shaving, no creams, no embarrassing moments at the pool or beach, no rashes.....NO problem!

Most women (and men) have hair they don't want.  It is a constant issue we all deal with.  With summer approaching, NOW is the time to start the process of hair removal.  How would you like to wake up and not worry about underarm hair, leg hair, bikini hair, back hair or any hair in a place you have to groom over and over again.  I want to assure you that we, at Total Body Surgical, have the best and latest technology to reduce hair in all areas at prices never before seen in the region.  

We have talked about hair removal and how it works in the past but a review is in order.  Laser hair removal has been around for some time and is very effective when in the right hands.  It works by killing the hair stem cells that create the hair from the follicle.  This image shows how the dark hair absorbs the laser energy and carries it to the hair creating cells in the follicle and eliminates them.  Through this process, the hair becomes thinner, lighter, and in most cases, is eliminated all together.  We can treat hair anywhere on the body with excellent success.  In most cases it requires an average of 6 treatments for body hair and 9 treatments for facial hair.  The treatments are usually spaced about 4-6 weeks apart to allow the hair to be treated in its different stages of growth.  Due to new hair follicle development during life, some people may require "touch up" treatments in the future, maybe a couple of times every few years.  Laser technologies do not work well on blond, white, or gray hair.

At Total Body Surgical we have the latest IPL and Laser hair removal technology.  Using the Cutera 1064 YAG laser and the Pro Wave 770 IPL we can treat most areas quickly and with minimal discomfort. 

Why are we different than all the other places??  In the past, laser hair removal was very expensive.  The technology is not what most would call cheap.  This equipment can cost several hundreds of thousands of dollars and treatments for larger areas can cost thousands.  At Total Body Surgical we realize that removing unwanted hair applies to all of us and not only the wealthy.  Therefore, we have concentrated on reducing our prices to rock bottom.  We are offering hair removal for $50.00 per treatment per area.  This means that you can have hair removed from an area...let's say underarms....that's an average of $300 for 6 treatments.  Bikini area.....$300.  Both areas.....$600.  This is an outstanding deal that is not a special, it is our usual pricing and it's hundreds less than most providers.  It is worth the trip to Grove and the lake to have this done and can be life changing in time savings and removing the stress of unwanted hair growth.

Come see us soon, and don't forget our other special prices!!!

Today, for the final installment on lasers, we are going to discuss the use of lasers to treat veins on the face, legs and elsewhere. 

First, leg veins.  Superficial or spider veins occur very frequently on the legs.  As I have discussed before, when the areas are large, I prefer injections to the laser because I can cover much more ground and cause less dicomfort.  For small areas, however, the laser is very convenient and in most cases works very well.  The veins in this picture are perfect....why??  Remember that laser light is attracted to pigment.  The darker the pigment, when the laser light hits it, heat is generated, the small vein is injured, the flow stops and the vein is gone.  After lasering the vein it turns red and forms a clot that slowly dissolves.  I use the Cutera 1064 laser for the darker veins.  For veins that have a lighter and more red pigment we use the KTP or 536 wavelength laser.

The second area that is most commonly complained about is the face.  Adults of European descent commonly develope visible veins around the base of the nose that are unsightly.  Those with Rosacea get veins that are visible on nose, at the base of the nose, and nearly anywhere else on the face.

The nasal areas we treat with the laser to close the veins.  For Rosacea, it may require several different methods, even systemic medications on some cases. 

The results we get are very good.  In most cases, new areas will arise and will require repeat treatments from time to time we call maintenance.

A third condition that is vascular and can be treated with laser are hemangiomas.  These areas occur in the young and old and anywhere on the body.  They can be very small.  They can also be very large.  Most of these can be closed with the laser.  Larger ones may require several treatments.  They turn dark, dry up, and are usually gone.

There are other uses for lasers but that about covers the more common things and I'm worn out with it.  We have covered how lasers work, hair removal, skin rejeuvenation, abnormal coloration, and vascular lesions....we treat them all.  Something new next week.

Don't forget our specials at Total Body Surgical.  We have a few surgical spots left before the first of the year then the summer countdown begins....believe it or not.