Total Body Surgical Blog

HAPPY NEW YEAR!!  After a two week hiatus....it is good to be back.  2012 will be an exciting year.  Lots of changes on the horizon for all of us.  Total Body Surgical will be entering its second year of service to Northeastern Oklahoma and the surrounding areas. Our success is all thanks to you.  Unless the Mayans are correct, we expect this year to be a banner one with many new changes to serve you better and MAYBE a few surprises!! 

New changes are happening this year for us.  This installment is to explain them.  Next week we will get back into the meat.

First of all, we will be adding to our team in the next few weeks.  We will be adding an ultrasound tech.  Why??  Well, as many of you know, I have been doing the pre and post treatment vein ultrasounds and quite frankly, it has become too busy for me to do them and keep up with everything else.  Our new tech will specialize in venous studies and as things in the vein center continue to grow, will take over more responsibilities with insurance and the daily running of the center.  Venous disease is way underdiagnosed and the Northeastern Oklahoma, Arkansas and Missouri are underserved when it comes to the newer techniques in varicose vein treatments.  We offer them all and as the word gets out and we continue to get great results we will need more help.

Second, we will be adding a new person at the front desk.  This is greatly needed to serve you quicker when you come in, answer phones better, and allow us to provide the service you have come to expect at Total Body Surgical.  We strive to be the best at everything we do.  We hate to make people wait and know your time is important.  I feel that the addition of our new staff will help us get closer to our goal.  Be assured that these new faces will be just as friendly and nice as Mekala, Myranda, and Janet are now.... or we won't hire them!!

Third, physical changes.  As many of you know, our corner in Grove has been undergoing massive change for the better.  The old hospital is gone, the old intersection....gone...and the new shopping center is well under construction.  The intersection, which has hindered access for several months is now finished with new curbing and asphalt.  It looks great and will serve all of us much better than the old one....thank you Grove!!  We plan to make some cosmetic improvements to the outer office, and, as you know, the interior is very nice.

Fourth, I will be making more YouTube clips.  We plan to film procedures, pre and post op instructions and more.  We will attach them to the web site so that you will have a better understanding of what goes on during your procedure and help address your questions and fears.

These are the changes we are working on for 2012.  Keep and eye out for the surprises!! 

The next few weeks I will talk a little about common General Surgical problems.  These may not be as fun as the Cosmetic and Vein discussions but are just as important, if not more so.

First we will talk about one of the more common problems...the gallbladder, then hernias, then endoscopy.  By that time we will be heading into spring.  I am working on some great pricing for "mommy makeovers" for spring that will include breast work, tummy tuck, and liposuction....very exciting.

Talk next week....Happy New Year!!

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.

Last week I tried to explain, in easy to understand terms, how lasers work.  Of course this is a very complicated subject involving physics and science so I tried to make it simple.  What you should try to understand is this....with lasers in Cosmetic and vein surgery, what we are trying to accomplish is using the right wavelength of light to excite or remove a certain color or tissue.  Over the next few weeks, I will attempt to help you understand what is possible using lasers.  I hope I am successful.

Today I am going to discuss how we use lasers to remove tattoos. 

When I was a kid....a long time ago....tattoos were one of the things that were considered very exotic.  You only ever saw them on merchant marines, sailors, WWII vets, etc.  I'm not sure when they came into vogue, but today, they are more than common.  Whether good or bad, they have also become much more complicated.

  (Typical WWII era tattoo...single color, small in size, shallow depth of ink)

Todays tattoos have multiple colors, can be very large, and use technology that puts the ink in the skin with more uniformity and depth. 

(new tattoo...larger, more colors, broad spacing, deeper pigment)

The other thing we see is that the inks are mixed to create some of these colors which makes it more difficult to remove.

People get tattoos for various reasons and they usually get them when they are young.  Later in life, as skin changes and we age, they may become less attractive...and...styles change.  Some designs may fall out of vogue.  Another problem is employment.  Visible tattoos that are difficult to conceal may become a problem with some job seekers.  They were put on without regard for the future.  We run into this often.  Individuals want to advance in a job but cannot because of policies against visible body art.  For these reasons, many people want them removed.

The simple fact is that tattoos are by nature associated with scar tissue which can never be removed.  For this reason, the skin can never be returned to its pristine, pre-tattoo state... but we can get close... most of the time.  In comes the q-switched laser (see last weeks blog for information on what this means).  The ink in a tattoo is deposited in the layers of the skin in "globs".  These packets of ink are a foreign body and our immune system is constantly eating away at them.  They are large though and this takes time....lots of it.  If you look at an older tattoo, the color is not as vivid, real old tattos may fade completely, and this is why.  By choosing the right wavelength of laser light and firing it at the ink there is a percussive effect that breaks up the "globs" into more manageable smaller deposits.  The body can handle these quicker and easier.

The easiest tattoos to remove are the black and red ones.  The q-switched 1064nm yag laser hits black very well and the q-switched 532 nm hits red.  When fired at the ink, there is a pop as it is dispersed into smaller packets that the immune system can handle.  The idea is to break up the ink without creating a lot of heat.  Too much heat can cause a burn and create a tattoo shaped burn scar.  The harder colors are greens, blues, and pastels.  For these we have to use blended wave lengths or pulsed dye lasers that have less quality and power.  Black and red tattos can usually be removed in several treatments 6-9, the other colors can take years to remove.  The other factor is the quality of ink used.  Some inks are easy and others are not.  Some inks contain iron oxides that are impossible to treat without creating heat AND resulting scar tissue.  Fortunately we see these inks infrequently.  That is what makes tattoo removal difficult and somewhat unpredictable.  There is a movement to standardize ink and this would be good.  It would make the removal process much more standardized as well.  Ethnic skin adds a whole other dimension to removal as pigment in the skin also attracts the light and changes in skin color can occur after removal that may be permanent.

Tattoo removal without local anesthetic is not without discomfort.  We usually use topical anethesia at a minimum and injected local on most.  Treatments are usually quick and done at 6 week intervals to allow the body to catch up absorbing the ink.  Removal can be costly due to the number of treatments and the expense of the laser equipment.  Q-switched lasers are not cheap and it takes multiple devices due to the different wavelengths required.

That's it...tattoo removal in a nutshell.  It is much more complicated but I don't want to overwhelm. Come see us at Total Body Surgical for a no cost evaluation and estimate if you want your tattoo removed....Call 918-786-7780 for an appointment to see our tattoo removal specialist or fill out the contact form and we will call you!!

Don't forget our special pricing on liposuction, lap bands, and nail fungus too.

I want to spend some time discussing lasers and how we use them today.  Lasers have been around for some time.  In the past, at least as far as medicine is concerned, they have been a technology looking for an application.  In the past several years, improvements in technology have made them much safer and applications have greatly increased.

  Austin Powers....demonstrated his ignorance of laser technology.  Lasers have been a mystery to most!! 

Laser and intense light or flash lamp therapy are both based on concentrated light.  Let's talk about lasers first.

Lasers are concentrated light that can be used for multiple applications.  They have been used in industrial applications for years. Medical lasers have numerous applications as well.  We use them to to clear up and make skin look prettier.  We use them to remove tattoo's.  They are used to treat veins and vascular problems on the body and face, even varicose veins.  We can remove unwanted hair, laser fat cells, make skin contract, use them to cut skin, and now we can treat toenail fungus which has been a nagging problem.

Pulsed light therapy is based on a bright flash of light shot onto the skin.  Also called a flash lamp, this technology has been used for other applications, photography, etc.  In cosmetic surgery we use it to treat spots and different pigments on the skin of the face or body.

Unfortunately, there is no single laser that can be used for all applications.  Not to get too complicated (because it is complicated) the way we choose what laser or lamp to used is based on the chromophore we are trying to treat.  A chromophore is the part of a molecule or cell that produces its color.  Each laser or flash lamp has a wave length that attacks that color.  This is why one laser or lamp will not work on all colors.  We know what colors we are trying to treat and select the laser or lamp that will work on that specific color.  This is where the art meets the science.  With some applications, we are aiming at water in the skin as the chromophore, especially when resurfacing the skin. 

The most common laser currently used in Cosmetic Surgery are the nd-YAG, the KTP, the CO2, and the pulsed dye lasers.  Each of these target a different chromophore or color.  The newest developments in the technology is the fractional and q-switched technologies.  We used to resurface skin by ablating or lasering the entire skin surface.  Since the skin recovers by healing from the hair follicle, recovery was slower than desired and this scared people.  Fractional lasers give us the ability to divide or fractionate the pulse of light from the laser.  This leaves islands of undamaged skin between the areas treated.  There are more and larger areas for the skin to heal.  The advantages are that healing is much faster and complication rates are less.  The disadvantages are that the treatment is not quite as good and may require more than a single session.  Q switching is a way to modulate the laser output to get a better "quality" of light energy, more intense output per pulse.  I will talk more about Q-switching when I discuss tattoo removal.

Flash lamps also treat specific colors in the skin.  They are used for treatment of brown pigment, red pigment, and hair in the treatment areas.  With flash lamps, we must change the wavelength of the light to treat each problem.

Now that the boring part is over, next week we will begin to explore the problems we treat and what we use to treat them.

Don't forget our nail fungus, lap band, and liposuction deals that are currently running.  We also are having multiple Botox events in Tulsa and Grove to get everyone ready for the holidays!!  Send me a message, fill out a contact form, or call 918-786-7780 to find out when and where.

Last week the discussion was all about the causes of venous problems that occur in over half the population.  This week the discussion will be about treating the problem and some of the common hurdles faced when attempting to encourage payment from our wonderful insurance carriers.  The good thing is that if criteria are met, insurance will usually pay for treatment.  What are the criteria??  Well, they are somewhat variable.  First, there must be symptoms.  Pain, swelling, skin discoloration, aching, restless legs, and at the worst, ulceration and chronic changes.  Second, there must be ultrasound documentation of the problem.  This includes dilation of the veins or vein, and reflux of blood which demonstrates the absence of proper valve function.  Third, many require failure of conservative therapy with compression stockings for varied lengths of time....in some cases for up to six months.  Of course, treatment of spider veins is NOT covered as it is considered cosmetic.  A great deal of the time, however, these pesky spider veins are caused by an underlying bigger problem with the larger veins and this is covered.  The reason that's good is that after treating the larger veins, getting rid of the spider veins usually is much more permanent and they don't come back!!

The way it works at Total Body Surgical, we see you for a consultation and examine the problem.  If it is obviously a venous issue, I will give you stockings to start your time requirement, if present, and schedule an ultrasound.  At the ultrasound, we will discover what the extent of the problem is and how many veins are involved.  At that point we will figure out the treatment plan.  The important part of the ultrasound is measuring how much and where the reflux is located and document this.  Once all of your insurance criteria are met, your procedure, or procedures are scheduled.  At the procedure we use sedation for your comfort.  We use the cooltouch laser and tumescent local.  The laser fiber is inserted into the vein, the tumescent local is injected around the vein and the fiber is activated and pulled back the length of the vein to heat seal it.  This redirects the flow of venous blood to the deeper system where it is supposed to go anyway.  Sometimes, depending on how many veins are diseased, this may require more than one treatment.

Pictured above is the laser fiber itself and a rendition of what happens inside the vein when it is inserted, activated and retrieved.

Next week we will talk about removing the large varicosities that branch off of the veins that are closed by the laser.  This is known as European microphlebectomy.

We are approaching the final week of the breast augmentation special and don't forget our lap band introductory offer.

New special for fall to be announced next week!!!

Thank you for visiting!

Well.....things have changed!!  Thank God!!  What has changed is advancement in ultrasound and laser technology.  Stripping was done to remove the vein that was causing the problem.  The laser heat seals and closes the vein accomplishing the same result without any of the downside.  The procedure is done in the office under mild sedation, patients walk in and are required to walk 30 minutes after the procedure.  The down time is minimal and I require patients to wear stockings for 2 weeks after avoiding strenuous activity. Large varicosities are removed through very small punctures in the office as well with no stitches and after a short time, essentially no sign of surgery. In most cases, if symptomatic and the ultrasound proves disease, insurance will cover this part of the treatment. Spider veins are then treated with sclerotherapy which usually is not covered by insurance but is very affordable. Afterwards, legs are nearly as good as new and usually none of the pain persists. Best of all you can take advantage of all the summer fashions. The success rate is around 80-90%....very good.

Come see us at INTEGRIS Total Body Surgical and get a great deal on cosmetic sclerotherapy after Laser ablation!!

COOL TOUCH LASER ABLATION

 At INTEGRIS Total Body Surgical, we provide the latest in total vein therapy.  When I first started in surgery many years ago vein stripping was the norm.  It usually required multiple incisions and a fair amount of blood loss.  The procedure was done under general anesthesia and required a prolonged recovery and left unsightly scarring.   The success rate was about 60=70%.  We know that this condition, known as chronic venous insufficiency, is inherited and aggravated by long periods on our feet and pregnancy.  It can also be caused by trauma, deep vein thrombosis and other abnormal clotting states.  The symptoms are caused by malfunctioning of the valves in the venous system.  Because of this, the venous blood pools in the lower leg causing pain, swelling, spider and varicose veins, skin color and texture changes, and possible ulceration.  It can cause restless leg syndrome, and makes them look bad.  Many people no longer wear dresses, skirts, shorts, or any other attire that shows leg because of embarrassment.  Others spend their life in hot and uncomfortable stockings with their legs elevated at night to deal with the discomfort. 

More later in the week on treatments.

  At INTEGRIS Total Body Surgical, Through July, we are offering $150.00 off of one sclerotherapy session if you screen and qualify for laser vein closure. See the link below for sign up and more details!!! Or call 918-786-7780 Today....don't miss out!!

http://www.totalbodysurgical.net/love-your-legsagain/

Video on how it is done.