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.

A good friend asked me to talk about fillers this week and I promised I would, so here goes.

First of all, what is a filler and why would someone want to use one??  Fillers are just what the name sounds like.  As we age, we lose volume in our face.  We lose it around the eyes, in the cheek area, and in the folds around the mouth and lips.  This is caused by hormonal changes and in many cases, genetics plays a significant role.

  As you can see in this graffic, as volume is lost, the skin begins to respond to gravity and "folds" in typical spots start to form.  Nasolabial folds are the most common, forming around the base of the nose to the corners of the mouth.  Secondly, "bags" begin to form under the eyes.  This is due to shrinkage of the fat pads in the cheek area that, in younger people, "windowshade" the fat pad under the eye.  This creates the dark circle under the eye which is really shadowing, as light is blocked by the overhanging fat pad.  The other commonly effected areas are the "marionette lines" at the lower corners of the mouth and vertical lip lines.  One other common complaint is thinning of the lips and loss of the youthful shape of the lip.

This picture depicts the "cone of youth" and how aging turns it into a box.  Again, most of this is due to loss of volume and loss of skin elasticity.

Now that we have covered what happens, what can be done about it?  There are a few ways we can correct or reverse the aging process.  The first thing I recommend is good skin care.  It wouldn't be right to fix up a vintage car and not re-paint the thing would it?  You want your skin to look as youthful as possible and I think Obagi is as good as it gets for that.

Second, we have to increase volume.  Even when we do face lifts to remove excess skin, most of us will add volume to fill up the upper part of the face...this is youthful.

The first and best way to increase volume is with facial implants.  They are solid silicone and never go away....one time and that's it.  The second best way is with fat grafting.  We use your fat, process it, and place it back in the face.  This is good because it can last a pretty long time...5-7 years.  The third way is with fillers.

Fillers have been around quite a long time.  First came collagen fillers that only lasted about 3-4 months and required skin testing.  We now have them that last a year or more and can be used in anyone.  The most commonly recognized one is Juvederm.  It is made of cross-linked Hyaluronic acid (HA).  HA is a substance that is present between our cells naturally.  Juvederm is clear and almost jelly like.

  It can be used literally anywhere in the face.  We use it to fill the cheek area, the nasolabial folds, marrionette lines, and lips.  It can also be used to correct nasal deformities or acne scars.  Think of it as putting dirt in a hole in your yard without disturbing the grass.  It is used to fill deformities or add volume to the cheek area, the nasolabial folds or marrionette lines.  It can be used to make lips larger or reshape them.    The second type of filler non-occuring in the body and made of a calcium compound mixed with a sugar based carrier.  This filler is good for volumizing but can only be used in deeper tissues. 

Radiesse is great for liquid face lifts where we place volume into the cheek area, lifting the face and restoring volume.  It can be used in nasolabial folds and carefully in marrionette lines.  It cannot be used in lips or in the dermis (skin).  Most other fillers on the market are made of HA, regardless of the name, except Artefill (made of collagen and spheres of solid material) and Sculptra (made of a powder material that causes collagen to form).  These two materials are made to inject deeply and last 5+ years.  All fillers have advantages and disadvantages.  You must consult with your injector to know which one is best to get the result you want.

My preferences are for Juvederm and Radiesse, for shorter term fillers.  I use silikon 1000 for my long term filler as it never goes away.  I use it to make great looking lips that stay.  I do small injections a month or so apart to get the right amount of correction.  Hope this helps everyone.  We love fillers and do them very well.  Call today and come see me at 918-786-7780.  All cosmetic consultations are complimentary.

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

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

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

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

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

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

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

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

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

melasma 

poikiloderma 

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

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

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

Sorry I've been out of the box for a couple of weeks.  Selling a house, preparing to move, AND the 4th tend to eat up the time.  Back to it today though and we're going to talk about your complexion.  It's easy to find great looking skin when youth is on your side.  How does she do it??
I have a few suggestions.  We start with good skin care and recommend Obagi products for damaged skin and Skinceuticals for good skin to maintain.  The next thing we do is laser treatments.  We like to pre treat with retinols and lightners to calm down the dark pigmented areas that occur from sun and hormones....why??...because treating these areas without pre treatment can cause them to recur with a vengeance.  Pre treatment is not a guarantee that they won't come back but it significantly reduces the problem. 

The next thing we do is recommend laser treatments or IPL.  The laser we use is the Cutera XEO.  For people that have significant sun damage, fine lines and wrinkles from the sun, and pigment issues, we use the Pearl laser.  The Pearl does a number of things well.  First, it helps eliminate skin discolorations.  It helps to create a more uniform skin tone and color.  It helps reduce rough patches that occur from solar injury and it can help reduce fine lines and wrinkles.  Treatment take about an hour using topical anesthesia, some mild oral sedation and the Zimmer which blows cold air on the treatment areas.  Recovery time for most people is about 4-5 days until make up can be used to cover the healing skin.  The skin will stay pink for a few weeks after treatment and gradually get to the uniform color you expect.  Remember that laser treatments take time.  We are stimulating new collagen formation and it doesn't happen over night.  It takes several months.  The newer lasers are less destructive too, so, be prepared to need more than one treatment months apart.  The results are worth the time though.

We like to maintain, after the treatments, with continued good skin care and peels.  We use low concentration glycolic acid peels that can be applied periodically at home to keep the skin looking good.

For pigment issues only we use IPL.  This is Intense Pulsed Light that targets specific colors in the skin, brown spots and red hues.  These treatments, also called photo facials, are effective in causing brown spots to disappear and red areas to decrease.  These treatments also take about an hour with topical anesthesia and the Zimmer chiller.

To recap:

1.  Good basic skin care to heal, maintain, and protect.

2.  Pearl laser treatment to rejuvenate the skin color and texture.

3.  Photo facials with IPL for those with pigment issues only.

4.  Continued good skin care and sun protection.

5.  Periodic maintenance with peels if needed.

There you have it!  The Total Body Surgical plan to keep your skin young looking and vibrant.  Our goal is to make you look good.

Don't forget our specials on breast augmentation, lap band, hair removal, liposuction, and toe nail fungus treatments.

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.

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!

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.

In the past few weeks we have discussed how lasers work, removing tattoos, removing unwanted hair, and renewing the skin.  These are important uses for laser technology and as it gets better, we will see more uses pop up.  Today I want to discuss pigment issues on the face, arms, and chest. 

Why do we get them and what are they??  is picture shows melasma, aka "pregnancy mask".  It is caused by sun in combination with hormonal changes.  It is quite common and cases can vary a great deal in severity.  These changes can occur on anyone but seem to be worse in ethnic skin.  It can occur over the entire face but is the most common on the cheek area.

The second area is on the chest.  Brown spots and red spots occur with age and again.....the sun.  Sun worshipers get this and the more you worship the worse it gets.

The third area is on the hands.  Age spots, liver spots, whatever you want to call them are caused by sun damage and can be present over the entire arm.

Even if you don't worship the sun, we all get exposure during normal daily activites of walking out doors, driving, etc.  So they can occur on any of us.

How do we treat them??  First, I suggest a good skin care regimen.  This is key to getting the skin to heal and to slow down the pigmentation process.  It also prepares the skin for more aggressive treatments.  At Total Body Surgical we like to use the Obagi system for treating damaged skin.  Obagi contains tretinoin and hydroquinone.  These stimulate the skin to grow faster and shed the dead portion of the skin.  It also turns off the melanocyte or pigment cell.  Lastly, it contains a good sun screen to prevent further damage.  Once used for a short period of time, we treat these areas in a couple of ways.  First is the IPL (flashlamp or Intense Pulsed Light).  This is a machine that shoots short bursts of intense light.  The wavelength is set to target the darker colors in the skin and some red pigments.  These areas then peel off and since the pigment cells are turned off, their recurrence is much less severe.  Continued protection from the sun makes them "stay away".  Treatments are usually done in a series of 3-5 treatments and the areas gradually disappear.  We can also use laser to resurface the skin and remove pigment.  The Pearl laser is perfect for this killing "two birds with one stone".  This gives you rejuvenated skin texture, helps with fine lines and wrinkles, and rids the pigment too.  Recovery time for this treatment is only about 4-5 days.  The IPL recovery time is minor redness for about 24 hours then crusting of dark areas that will peel off.  The Obagi system causes the sensation of dryness and may cause some minor shedding of dead skin for a few weeks.

Come see us at Total Body Surgical where our staff is trained and experienced with Obagi and Skinceutical products.  We also have a full product line in the office and can get you started.

Remember our specials that are still going on too!!

Call 918-786-7780 for a complimentary cosmetic consult or fill out a contact form and we will contact you!!

More laser stuff next week!

We also have special Christmas pricing on products and gift certificates available for all laser services and skin care, Latisse and more!!