Total Body Surgical Blog

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.

Let's take a break from liposuction this week, we'll wear that out some more later!!

Dr Miller and I just did an interview with the Joplin television station and the topic was addressing extra fat and skin in the upper arms with arm reduction.  I will put a link on the website after it runs if you want to have a look.

First of all...What the heck is an arm reduction?  Also known as a brachioplasty, it is the removal of skin or fat from the upper arm.  

As you can see from the picture, the upper arm has very loose skin with a little excess fatty tissue.  Compared to the lower arm, it looks "odd" and makes some people very self conscious.   Also, when trying to buy clothes, people will avoid sleeveless attire and buying sleeved clothes is hard due to the large diameter of the upper arm.

The image above shows where we usually make the incision.  I normally will liposuction the upper arm to get the maximum reduction, then remove the excess skin.

This photo shows a good before and after.  The results are pretty striking.  The down side in Cosmetic surgery, and the trade off, is always the scar, but these tend to lighten up with time and for most, it is worth it.  Some make the incision along the lower part of the upper arm but I personally think the least visible area is as shown.

Who wants an arm reduction??  There is no single answer to that question.  I guess the easiest person to pin point is the one who has had massive weight loss after dieting or weight loss surgery.  In some, the skin tightens to a satisfactory level so it does not hang, however, in others, they lose the weight, the skin sags and becomes a problem.  In summer fashions with short or no sleeves, the excessive skin can make someone very self conscious.  Some people just gain weight in there arms.  This, of course, is related to your genetic layout.  For some, liposuction will do.  Which procedure is best for you?  That depends on the amount of skin and its quality.  Skin that has stretch marks, is already thin but still hangs, or where there is just too much, will probably benefit from reduction as liposuction can only cause a small amount of skin contraction no matter what technique is used.

The procedure can be done in the office for smaller arms or in the hospital for larger ones.  It usually takes us about 2 hours to complete and is done as an out patient.  Personally, I use drains only in the larger arms and all others I don't.  We like for you to be very careful and baby the incisions for about 6 weeks so the scar that does form is minimal.  Due to the high motion of the area, we will tend to revise these scars more often than most in the office to make them look nicer.  The first time they are closed, there is tension on the wound and this tension, combined with motion can make the scars wider than we like.  When revising, we are only working with the scar.  There is much less tension after revision and they will heal better in most cases.  Many times, we only need to revise a portion of the scar which also makes it easier.

Why the rise in people wanting a reduction?  I don't know the exact reason but I think awareness is one thing.  Many did not know there was a solution to the problem but now do. The other reason is the rise in obesity and weight loss surgery.  With massive weight loss surgery and the desire to "get the old body back" an arm reduction is the only solution for some people.  

Come see us at Total Body Surgical where we are experts at all types of post weight loss surgery....we also do the weight loss surgery, so we have the experience. 

Call 918-786-7780 today or 1-866-weight0 for a consultation at no cost to you.  With you, we will decide which procedure is best.  

Don't forget our laser liposuction deal...$999 per area....can't beat that....call today!!

Latest news coverage for Total Body Surgical and Green Country Bariatrics from Joplin, Mo.,.....check it out....
http://www.koamtv.com/story/20349961/integris-grove-fights-back-against-obesity-with-help-of-new-surgeon

Vaginal Rejuvenation....well, don't expect a lot of pictures for this one folks!!  A very touchy subject to be sure.  I'll try to get through this without offending anyone, here goes.

Why vaginal rejuvenation?  The simple fact is, the vagina does a lot of hard work during pregnancy and delivery.  The tissues in the vaginal wall, the labia, the cervix all stretch to incredible size to allow the infant access to the outside world.  The aftermath can leave changes that do not resolve.  For men, imagine trying to stretch your lips around a watermelon then returning to normal....impossible right?  My point exactly.  The vagina and labia undero chronic changes and never return to the pre partum state.

What changes occur?  The outer appearance changes that occur are numerous, but the biggest ones that most women notice are a thinning of the mons area with a loss of fat in the mons and labia majora.  Secondly the labia minora becomes effaced (thinner) and become stretched and longer.  In some cases the labia minora may protrude beyond the labia majora.  The third change that most women notice is a change in the coloration of the labia majora.  It can become much darker, losing its original pinkish hue and becoming brown or in some cases almost black.

The inner changes that can occur are also many and can be complex.  As the infant travels down the vagina, it stretches to a very large size.  Hormones cause the tissue to become very elastic to allow this to occur, however, damage may be done, especially when large babies deliver.  One of the common internal changes that occurs is the enlarging of the vaginal diameter.  This can have long term effects when it comes to sexual satisfaction for both the woman and her partner.  Other things that can happen that are a little more severe and beyond the scope of Cosmetic Surgery are cystoceles and rectoceles.  Cystocele occurs when the connective tissue of the front of the vagina tears and allows the bladder to fall into the vagina.  This can cause difficulty in holding the urine and also cause an unsightly bulging to the front of the vagina.  Rectocele is when the same thing happens in the back wall of the vagina and the rectum bulges in.  These problems can occur simultaneously and may require a surgical procedure to fix, if they are bad enough.  The common problem we deal with is just trying to tighten the vagina after it has dilated, recovered from delivery, but just not to the pre delivery state.

How does this effect Cosmetic appearance??  Well, I'd show you some pictures, but for the sake of modesty, I'll pass.  With newer summer fashions, swim wear, tighter shorts and pants, in many cases the changes can be seen under clothing.  Also, many women are self conscious and are embarassed when naked with their partner, not to mention the decrease in sexual satisfaction.

What does this have to do with Cosmetic Surgery??  Our goal at Total Body Surgical is to take care of all of the Cosmetic needs of our patients and this is a Cosmetic need.  What we do to fix the problem is using one or two procedures.  They can be used individually or in combination.  The first is the labiaplasty.  What this involves is removing the extra and discolored labia.  Labiaplasty leads to a more pleasing appearance to the external genitalia and can also help with the appearance in clothing.  This is a quick procedure with very little down time and in many women, it can be done in the office with some IV sedation.  Healing in this area is very quick and there is only minimal discomfort.  Added to this, to address the thinning of the Mons area, we will often do some fat grafting in the area to make the outer appearance of the mons and labia majora look more youthful...it can make a huge difference.  Second is addressing vaginal laxity.  How do you deal with this??  We make a very small incision at the base of the back of the vagina and insert a laser fiber.  The laser energy causes the vagina to tighten over the next few weeks.  We also tighten the entroitus a little and close the skin.  All of these procedures can be combined and can be done in the office for select patients.  Others, can be put to sleep in the Operating room if that is desired.

What you have when finished is very much like what we see in a face lift.  No fundamental change in the anatomy, just the appearance you had before age and children altered it.  Also, an improvement in the vaginal function.

We recommend that the procedure ONLY be done after having ALL of your children!  It is also a procedure that can be combined with other GYN surgeries, like tubal ligation or hysterectomy.

Come see us today and we'll talk about it....918-786-7780.

Click on the buttons to see our special offers!

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.

"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!!!

 Don't we all have unwanted hair??On the face maybe??

  Feel like you are wearing a sweater all the time due to unwanted back, arm, or chest hair??

  Tired of shaving those legs??  That's a lot of real estate to manage isn't it??

Maybe you are tired of managing hair in those unmentionable places??

Hair is a funny thing.  It seems that where we want it, it doesn't grow, and where we don't want it, it grows like crazy.  In society today, hair on the body is not a desirable thing.

Traditionally, hair has been managed by a number of means...all of them temporary.

  Tweezers have been a common tool along with razors, shavers, and even hot wax.  Everyone has seen movie scenes where the star is punished by waxing large tracts of hair (40 Year Old Virgin)....it looks terribly painful and not much fun.

Now that laser and pulsed light technology is common, it can be used very effectively to reduce the volume and thickness of hair in almost every area.  As we have been discussing in recent blogs, laser light effectiveness depends on wavelength.  Hair grows from buds that contain pigment and stem cells.

  When the appropriate laser light and energy are used, the hair conducts heat into the bulb of the hair and when in a growth phase, the stem cells are heated and damaged.  Over multiple treatments, the bulb is damaged to the point that it can no longer produce hair.  Multiple treatments are required due to the fact that hair grows at different rates and some follicles are actively producing and some are dormant.  New follicles can also generate in areas that have never produced hair.... i.e. the new hair that forms on your face or back that was never there before.  Lasers and IPL can be used in essentally all areas to remove hair.  The most effective areas are for body hair.  Because it is usually dark and thick, it conducts the heat into the follicle most effectively.  Body hair can usually be reduced by 80% or more in just six treatments 6 weeks apart.  Facial hair is usually thinner and less dark.  Therefore, it usually requires 9 treatments 6 weeks apart or more for lighter hair.  Very light white hair is usually not conducive to laser as it reflects all light and does not conduct heat.

If you are tired of all of the other temporary fixes for unwanted hair.....try laser hair reduction.....it works.  We use the Cutera system at Total Body Surgical.  It is a time tested platform that uses both laser and IPL.  This gives options for some of the more stubborn areas.  It is also easy to afford.  It used to be pretty pricey but now is in most peoples price range.  At Total Body Surgical we charge by the treatment and have many options if multiple areas are to be treated.  We charge $50.00 per treatment for a small area (face, underarms, bikini) and $75 for large areas (full back or chest or abdomen).  Do the math and you will see how over time you actually save money over waxing, shaving or creams.

Call us today to make an appointment...918-786-7780 or fill out a contact form.

Don't forget our other special deals on liposuction, nail fungus, and lap bands!!  

I hear you....OK....it has been a lot of information on skin...I know.  This will be the last installment on skin, at least for a little while.  I am going to talk a little about skin color changes or dyschromias.  No YouTube this week...couldn't find a good one for ya'll.

What causes dyschromia in our skin??  The same old things...too much sun and poor skin care habits.  Added to these problems are hormone changes, rosacea, venous changes in the skin, skin thinning with age, etc.  All of these problems create the browns and reds that become apparent as time progresses.  The terminology for dark spots are poikiloderma or brown spotting that usually occurs on the chest after years of tanning and melasma or brown discoloration on the cheeks and face in a mask like distribution.  Melasma can occur in younger women during pregnancy and is certainly related to hormonal changes with pregnancy and menopause.  When the sun is added to these changes, it can be dramatic.  We also can get vascular changes in the face.  The most common areas are on the cheeks and around the base of the nose.  Here you may see visible veins, small cherry red spots, even a generalized redness.

After identifying the changes, what can we do about them?

There are many approaches and all of them begin with good basic skin care.  I recommend some type of retinol cream and a topical vitamin C along with this.  To help tame those brown spots I also add hydroquinone to turn off the melanocyte that produces the pigment.  Retinols are vitamin A compounds that help thin the "dead" layer of skin and stimulate growth of new skin.  Over time they make a big difference.  Sun screen is also crucial to help stop the damage.  At Total Body Surgical, we use the Obagi system because they are pharmaceutical grade and make a dramatic difference over time.

After taking care of the basics we can address the color issue with lasers and Intense Pulsed Light or IPL.  The IPL is a flash lamp system with wavelengths that target the pigment we want to get rid of.  The reds are diminished and the browns crust off while turning off the melanocyte.  IPL treatments are usually done in a series of 3 to 5, about a month or so apart to be successful. Vascular lasers are used to treat hemangiomas, visible veins, and larger red spots. These treatments can be combined with milder forms of laser skin resurfacing.  At Total Body Surgical we use Cutera technology.  This system has the Limelight IPL system that is good at treating multiple pigments in the skin.  We also have the Pearl which is mentioned in this segment,

http://youtu.be/0goYcY3LTqQ

The Pearl is a good way to get immediate results with the added benefit of "buffing" the skin.  This creates a new skin feel that is softer, recreating that glow that is age defying.  The treatments can be "stacked" on each other to get the benefits of both.  When used for treating pigment, recovery times are usually no more than 4 days.

Well, that about covers the face.  From facial skin care to face lifting and implants.

We have extended the breast augmentation special pricing through July so don't miss out, -Breast Aumentation....ACT NOW!!!

I am also working on a special Pearl package for the fall (you should not be tanning when we do it) as this is the perfect time to start.

Next week....tackling obesity with the Lap Band!!!

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

http://youtu.be/iNQ3BHKm57o

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

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

Come see us where cosmetic consultations are complimentary!!

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

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

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

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

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