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

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.

What is IPL?  It is a great way to remove unwanted discoloration or dyschromias on the face, chest, hands...anywhere on the body.  It is the use of Intense Pulsed Light or a flash lamp to influence the pigment cells in the skin. 

How it works is by using a specific wave length of light that targets certain color in the skin.  The color we usually are after is brown.  Age spots, liver spots, whatever you want to call them, are a problem caused by skin aging and sun damage.  They are present on sun exposed parts of the body.  The IPL is absorbed by these brown areas that then peel off and are gone.  The melanocyte (the pigment cells in the skin) is encouraged to turn off and when the skin is then protected from future sun exposure, they usually stay away.

  (melasma or brown spots from the sun)

We like to combine good quality skin care with Obagi products to speed up the effects of IPL and make them longer lasting.  The Tretinoin and hydroquinone causes the skin to grow faster and the hydroquinone turns the melanocyte off.  The IPL gets rid of the current brown spots and voila your skin begins to look like it did before the sun and baby oil did its damage!!!

Red spots on the skin can be caused from sun damage as well.  Also causing the problem are small blood vessels in the skin.  To treat these areas the wave length is different but the process is the same.  The small blood vessels are injured by the light, closed, and the vessels are broken down by the healing process.  The red areas are removed.

Usually, IPL treatments are done in a series of 3-5 treatments.  Once problem areas are gone, protection from the sun is the key to long term success.  

A treatment consists of about a 20-30 minute application of a numbing compound.  We wash that off and the actual treatment takes only a few minutes.  Hands can be treated as well and most want the decollatage or chest area treated too. 

We use the Cutera XEO system which allows us to use multiple wave lengths or combine wave lengths in a single treatment.  At Total Body Surgical we charge $150 per treatment and we have special pricing for packages of multiple treatments which is usually required.

Don't forget our breast augmentation specials on silicone and saline AND we are having great success treating nail fungus with the laser.  Our lunch time lipo special is still running also and our laser hair removal at $50.00/treatment/area can't be beat!  We have people driving from Memphis, Tn because we are so cheap!!

Call today for a consultation..918-786-7780.

Last week we talked about eyes, the window to the soul.  Today we are going to discuss another part of the anatomy that can instantly tell your age.

Youthful lips are generally very full and inviting.  They are made of the white line where the skin and the pink mucosa of the lip join and the fullness of the lip takes off.  The cupids bow is in the center of the upper lip giving definition and contrast that the lower lip is missing.  Usually the lower lip is slightly larger than the upper.  Youthful lips are smooth and surrounded by skin that is also smooth with uniform color and texture.

  So what happened??  A number of things.  Skin aging, sun damage, volume loss, i.e. fat, around and in the lip, smoking, using straws, smiling, frowning, kissing and just time.  All of these things age our entire face but since the mouth is one of the centers of motion and expression in the face, like the eyes, it shows the use as we age.  The lips become thin and surrounded by vertical lines, nasolabial folds, marrionette lines.  The "white line" becomes less visible and the "cupids bow" becomes a straight line.

How can we repair the damage??  We can lift the tissue around the lips, correcting the cheeks and neck.  We can correct the nasolabial folds by adding volume in the form of a filler (Juvederm, Radiesse, fat grafting).  We can do dental correction to improve the underlying structure if needed.  To correct the skin damage, it is important to improve the skin.  We can do this in a few steps.  First, good skin care is critical.  As stated here before, we recommend Obagi products that combine Tretinoin and hydroquinone to correct color changes and improve the texture of the skin.  We then can augment the lips using temporary fillers like Juvederm or more permanent fillers like Silikon 1000.  This replaces the volume that has been lost.  Lastly, after pre-treating the skin with Obagi and repairing sun damage, the deeper wrinkles and vertical lines remain.  What to do about them?  They can be filled if extremely deep, again, with a temporary filler.  The best way to treat the area is with laser.  Resurfacing the area promotes new collagen production, softens the wrinkled areas, and removes the sallow color of the skin.  I usually recommend doing the entire face along with the area around the mouth.  This removes transition zones and looks more uniform.  We use the Pearl laser which is great for this.  It has a faster recovery time than similar lasers, can be spread over multiple treatments, and gives great results.  The price for the first treatment is only $1000 and repeat treatments are $500.  Most require 2 or 3 treatments for a great outcome.  The order should be, skin care, laser, then filler as some laser treatments can degrade the filler material.

Come see us for lip rejuvenation.  We carry a complete line of Obaji products and fillers.  Also Botox that can help prevent some of these changes.

Don't forget our other specials too....summer is approaching rapidly!!  Breast augmentation starting at $3799.00!

                                                                                      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!!!

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).

Let's talk about liposuction ....again.  If you didn't see this spot on the 40/29 Fayetteville, Arkansas news, have a look!

http://www.4029tv.com/news/30406524/detail.html

Remember "smart lipo"??  Well, it is still around but there have been improvements.  Smart lipo is when a laser is used to destroy fat cells in problem areas.  It has been touted as being less traumatic and with faster recovery times.  It became available in 2007 and was all the rage for awhile.  I was in my cosmetic training at the time and we were the first ones in Oklahoma to have a machine and we taught courses on how to use it for Cynosure, the manufacturer.  The idea was that the laser energy destroyed the fat cell and the remains were resorbed by the body.  The skin would contract and you would have a new contour.  What we found (and what many studies have shown) is the results were not as good as traditional liposuction because the volume of fat destroyed and removed was not adequate.  What has been shown is that the heat generated by the laser does cause the skin to contract better than with traditional methods.  The take home message is this...liposuction is best for removal of fat and contouring the body.....the laser energy works to heat the skin and cause it to contract to its new position.

So what is "lunch time" lipo??  It is combining liposuction, laser liposuction, and tumescent anesthesia to treat small problem areas without sedation or other anesthesia.  The key word is SMALL.  We all know, through intuition, that a procedure that involves treating a large area or multiple areas cannot be done without some recovery time AND for larger areas we sedate you for comfort and to make it a good experience.

At Total Body Surgical our Laser liposuction is done a little differently.  I use the CoolTouch laser that has a slightly different wavelength, the major difference is the cannula we use.  With traditional liposuction the fat is removed with a hollow cannula.  If the Smart Lipo is used, the laser cannula is then used to heat up the skin causing contracture of the skin.  With our machine the cannula is combined.  This allows me to liposuction and laser simultaneously, saving time with better results.

Come see us for a complimentary consultation and I will cover options with you.  What is a "small area" that would qualify for the lunch time procedure??  It would be a single area such as the neck, saddle bags, inner thighs, lower abdomen, hips.  You would arrive at the office and we would mark the problem area in question.  We would numb the area with tumescent solution and make a small incision in the skin.  The cannula is inserted and the laser turned on.  The fat is removed and the skin heated simultaneously.  You may drain from the areas for about 12 hours and we would want you to wear a "spanks" garment for 3-4 weeks.  You may have some bruising and some minor discomfort for a few days.  Please see my portfolio page to see some pictures of my patients before and after photos.  See our lipo specials too...we have great deals for the spring. 

It hurts when I eat!!!  This is a common complaint I hear almost daily.  As you know, at Total Body Surgical, we not only take care of Cosmetic Surgery patients, Vein patients, and obesity problems but General Surgical problems too.  Many times, procedures can be combined to tackle two problems at once. 

Abdominal pain comes in all forms and everyone experiences it differently.  Pain in the right side of the abdomen under the ribs is a very common problem.  This type of pain is usually the indicator of a failing gallbladder.  It starts with pain after fatty foods but may advance to pain after any food.  This pain may be felt in the back, usually at the tip of the shoulder blade.  It may also present as indigestion.  The pain usually starts as mild discomfort but as time goes on, it becomes more severe with spells becoming closer and closer together.  It may be associated with nausea and vomiting as well as changes in bowel activity.

What is a gallbladder???? 

The gallbladder is a small, pear shaped organ at the base of the liver seen in the picture above. What does it do??  It is a small storage depot for bile.  What is bile?  Bile is a salt in solution that is formed and recirculated by the biliary system in the liver.  What does it do?  Bile is a solution that helps us digest and absorb dietary fat.  Without it, fat just sails on through the digestive system and causes diarrhea.  With it, the fat is emulsified and absorbed to use for energy.  When a meal is eaten that contains fat, the normal gallbladder is stimulated to release a bolus of bile into the intestine.  The bile mixes with the fat and it is digested and absorbed.  What goes wrong to cause pain and gallstones? Pain is caused when the gallbladder is stimulated and it cannot contract properly.  This causes a cramping type of pain (colic) in the right upper abdomen, back, etc.  Bile is a salt in solution.  If you take a jar and put salt and water in it, mix it up and keep it moving, the salt stays mixed in the water.  If you stop the mixing, it can settle and form crystals at the bottom of the jar and if you roll those crystals around they can come together to form larger crystals or stones.  This is what happens to the gallbladder.  It loses its ability to release the bile when stimulated and the bile salt comes out of solution and eventually the crystals form gallstones.  The stones are a symptom of the real problem....the gallbladder itself. 

Once the symptoms become severe enough, most people will seek medical attention.  The diagnosis is made with some fairly simple tests.  First, the ultrasound.  This is a simple and pain free test to detect stones.  If stones are present and you are having symptoms the gallbladder should be removed....more about that in a minute.   If the ultrasound is negative and the symptoms are convincing, usually a HIDA scan is ordered.  This test is done to see how the gallbladder is working.  It involves an injection to fill and then another to stimulate it to work.  If it does not eject its bile normally, it should be removed.

Today the gallbladder is almost exclusively removed using a laparoscope.  This is usually an out patient procedure done through small incisions and recovery is pretty quick.  Incision placement is pretty standard... Here is a picture of gallstones....not too pretty.

  We can live normally without a gallbladder in most cases, especially a sick one.  Some people may experience a little diarrhea that usually resolves but most importantly, the pain is gone.  If the disease is not treated, the stones can escape the gallbladder and get into the duct causing bigger problems that we won't discuss here.  The gallbladder can also become infected which can be an emergency.

This procedure can also be combined with a tummy tuck when done electively.  The incisions are not made through the skin but under it so nobody will ever know....pretty cool!

Come see us at Total body surgical Cosmetic and Vein Clinic where we can discuss General surgical, Cosmetic, Vein, and Obesity issues.  Don't forget our special pricing AND keep an eye out for our soon to be announced spring roll out!

Speaking of bulges....This week we are going to shift gears a little and talk about some General surgery.  When we look at the abdomen and see something bulging, it usually means there is a hernia present.  Hernias are a very common problem.  Many people are born with them.  The most common places for this type of hernia is in the groin area (usually in men) or in the belly button or umbilicus.  These areas are where natural weaknesses are present from either the umbilical chord or where the testicles descend.  Other hernias that can form present themselves in the mid line of the abdomen or more commonly in incisions from other surgeries. 

What exactly is a hernia??  Our abdominal wall is composed of layers of muscle and connective tissue.  The connective tissue looks like a thin tendon.  All of us who have cut up meat or a chicken have noticed the shiney layer of whitish, tough tissue that surrounds the muscles....this is connective tissue or fascia.  Pound for pound it is very tough and it is responsible for holding in the contents of the abdomen and gives the muscles something to pull on when they contract.  A hernia occurs when there is a hole created in this layer and contents of the abdomen poke through that hole.  The mid line of the abdomen (especially the belly button) and the groins are the weakest areas and therefore are the most common sites for naturally occuring hernias.  Here is a picture of an inguinal hernia...

Here is a photo of what the hole looks like from the inside using a laparoscope and as you can see, with the contents removed, there is an actual hole.

  Hernias become a problem when things get stuck in them...things like intestines, fatty tissue, and other contents of the abdomen.  They can also cause discomfort due to stretching of the wall of the abdomen with straining to lift, urinate, or have a bowel movement.  Things can also become stuck, lose blood supply and die within the hernia.  Small hernias may never cause a problem.  These are the common hernias of the abdominal wall.  I won't cover the more obscure ones due to time and the others are fairly uncommon.

How do I fix them??  Today I usually fix them with laparoscopy.  This allows me to repair them with mesh that incorporates into the surrounding tissue creating a strong patch.  It also cuts down on incision size, wound infections, recovery time (minimally) and I think leads to a better repair because I can see the defect or hole better.  The mesh is placed with a great deal of overlap and tacked in place.  Meshes have small holes in them into which our bodies incorporate scar tissue making them very strong....like chain link fence on grass, the collagen holds them mesh in place making it very hard to move.  Recovery times are usually about 6-8 weeks allowing the mesh to scar in.

So, if you have a hernia, come see us at Total Body Surgical where we not only do Cosmetic surgery and Vein surgery but are professionals at General Surgery too!!

Don't forget our specials and friend us on Face Book PLEASE!!    

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!!