Total Body Surgical Blog

Let's have some fun today.  It's been a little while since we had a little audience participation and I think it is time to change that.  Sooo, it's test time again!! 

Here are the rules:

1.  Look at the picture and see what you think would help.  (those of you who come here often will find it easy...you are educated!!).

2.  The choices will be between using Botox, a Filler of some sort, laser, or a surgical procedure.

You may elect to combine the use of these tools and that is OK.  I do it all the time.  Today though, let's not get too complicated.  In my analysis of the patient I will give you some ideas on what other things would be good for the patient.  I need to feel useful in some way!!

Always remember, there is no right answer, because, in Cosmetic surgery everything is elective.  You can always choose to do nothing.  However, there are wrong answers.  Wrong answers are when you plan to do more than the patient needs or wants.  My job is to steer people away from unecessary procedures and only do what's needed or desired...today, that's your job.  Good luck!!

Example #1: 

Here we have a 40'ish female with no other medical problems.  She complains that she looks "old" and wants a face lift or something to help her look the way she feels.  Look at her closely.  What do you think??

What would you recommend:

1.  Botox  2.  some type of filler  3.  laser  4.  a surgical procedure

Example #2:

40'ish young lady who complains about the lower part of her face sagging.  Her friends have told her that you have helped them and she should come talk to you about what could be done.  You would recommend???

  Your recommendation??

1.  Botox  2.  a filler of some type  3.  laser  4.  a surgical procedure

Example #3:

A 54 year old lady who is disgusted with her neck and just thinks she looks OLD!!  She says that cost is no obstacle and wants it all fixed, or injected, or something! 

 And the winner is....

1.  Botox  2.  some type of filler 3.  laser  4.  a surgical procedure

Example #4:

28 year old female who states her boyfriend says she has "wrinkles around her mouth".  She is concearned about this and wants to know what you think....

  Here she is...

1.  Botox  2.  Some type of filler  3.  laser  4.  surgical procedure  5.  get a new boyfriend!

Example 5:

A 65 year old widow comes to you and says she has finished mourning the loss of her husband and wants to look younger so she can "get out there".

  Very nice lady....funny too....what would you recommend??

1.  Botox  2.  some type of filler  3. laser  4. Surgical procedure  5.  Birth control

Well, let's see how you did.  On number one if you said Botox, that would be a great start.  Most people want to start small.  Botox would get rid of the lines around the eyes and in the upper face.  She will eventually probably want a brow lift to eliminate the lines and the cause of them but Botox is fairly cheap and less invasive.

On number two, I would say Botox and some type of filler.  This combination is great for softening wrinkles in the upper face and getting rid of nasolabial folds as this lady has.  She has good facial structure and her skin is in good shape.  This will make her very happy and not cost a fortune.

On number three, I would recommend a surgical procedure or two.  Looking at the "hooding" over her eyes, she would benefit greatly from a brow lift.  It will take years off of her appearance.  She also has the "turkey gobbler" neck and jowling but her neck is not heavy.  I would recommend a mini lower face and neck lift as well.  She will be very happy!

On number four....get a new boyfriend of course.  We see people like this sometimes and my job is to DO NOTHING.  She needs to be told how beautiful she is and just how silly it would be to do anything to change that.  Unfortunately, in many cases, these people will find someone to mess things up.  It's sad.

Number five would need a brow lift, upper eyelids, face lift, and I would also recommend full face laser to treat the discolorations and fine lines on the rest of the face.

I hope you did well on the quiz today, and enjoyed using your own evaluation skills.  If you like, let me know how you scored and if you have anything you would like addressed, send that too.

Call us at 918-786-7780 or 1-877-weight-0 to make an appointment.

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.

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.

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

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

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

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

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

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

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

918-786-7780

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

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

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

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

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

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

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

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

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

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

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

I guess the test last week was not so good judging from the response.  A few people really loved it so I may consider doing another in a few months....maybe on breasts...lift vs augmentation alone....or....faces, mini vs. full face lift....we'll see.

Today I want to discuss the Pearl laser.  Lasers have come a long way in the past 10 years.  We have gone from a technology looking for a procedure to actually being able to make a huge difference in a number of skin issues.  The great thing is that recovery times and safety have jumped in leaps and bounds. 

There are many reasons to choose laser skin resurfacing.  What resurfacing can do is:

1.  Reduce facial skin discolorations such as brown "age spots" and other discolorations.  These are caused by sun damage and age.

2.  Reduce fine lines and wrinkles in the face, neck, under the eyes, and crows feet.

3.  Shrink pores that are enlarged.

4.  Improve acne scarring.

5.  Improve skin color and texture.

6.  Improve vertical lip lines.

Why the Pearl??  The Pearl laser is fairly new technology that is similar to the CO2 laser.  What makes it good?  There are a number of reasons the pearl is superior.  First is recovery time.  The recovery time from the average treatment is only about 4 days.  This means that new skin reforms quickly, much quicker than the CO2.  Second is cost.  The cost of the Pearl treatment is $1200.  Compared to the CO2 this is less than half.  Third, you don't need general anesthesia.  We usually do the procedure with some mild oral sedation and topical anesthesia. 

The Pearl is made by Cutera..hit this link for more technical information.  Here is also a video from The Doctors that talks more about it.

www.youtube.com/watch?v=8OBi5AcQwWQ

Come see us and you won't be sorry....your youthful skin awaits.

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!

"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!!!