Total Body Surgical Blog

Hard to tell by the weather, but Spring IS here, not only by dates, but soon the warmer weather too.  In keeping with our Spring $3500 breast augmentation offer, we will discuss breasts.  There are a little over 3 weeks left to take advantage, so click on the button below to get details and fill out the contact form.  We'll get back with you.  Or call 918-786-7780 or 1-866-weight0 to schedule an appointment that will be complimentary.

I think we have about beat this subject to death but wanted to go into a little more detail about approaches to implant placement and some of our thoughts.  This will help YOU decide.  You deciding seems to be a recurring theme here, but you need to happy with your choice of implants and how they are placed.  Understand that we are happy if you are happy!!  The size you choose, the insertion approach you choose is all about you, not us.  We are here to help guide you in making your decisions.  Dr Miller and I have a great deal of experience with these choices and can help guide you.  Trish, Janet, Rachel, and Wendy also have experience, some have had this type of surgery and they are here to help too.  They are also WOMEN, this gives them a leg up, as politically incorrect as that statement is!!

A couple of things that have been glossed over you need to know about....

1.  Sizing:  When it comes to the size of implant you want or need, there are several factors involved.  Your height and weight.  Your build, thin, athletic, or larger build, your current breast size, and your desired size after augmentation.  We always hear comments on implant size based on what the internet says or friends comments, or the size someone else received.  You can usually throw all of these comments and suggestions out of the window.  Why??  You are unique.  The amount of breast tissue you are starting out with is not exactly the same as everyone else.  The size of your chest is not the same as everyone else.  You are taller or shorter, thinner or fluffier than everyone else.....one size DOES NOT fit all in this situation.  We start off by talking to you to get an idea what you want.  We then measure your current breast location, how big the current breast is, and the size of your chest. This helps us to figure out a range of implants that will be right for you.  If you have 100cc of natural breast tissue and want to increase to a 400cc breast, we need to look at implants around 300cc.  If your friend started out with 300cc of natural tissue and ended up with a 200cc implant, she may think your 300 is "large" when if you consider where you both started....it is about the same...right?.....right.  We will allow you to try different sizes on, in your clothes, so you can get an idea what you will look like.  We will also help you choose the style of implant you want.

There is a new higher profile not pictured here.

2.  Placement approach:  How do you want the implant placed??  Also an important question.  The options for saline are, armpit (transaxillary), below the breast (inframammary), through the nipple (peri-areolar), or through the belly button (TUBA).

 Arm pit incision-saline or silicone.

The incision is only 2-4cm, not this big!! Saline or silicone.

incision around the nipple. Saline or silicone.

Silicone cannot be placed through the belly button.

We all have our preferences but we are here to help you decide what YOUR preference is.  Here are the ones I don't like.  Peri-areolar approach is less ideal because it can cause sensation changes around the nipple and leaves a scar on the breast.  I also am not too fond of the TUBA.  It has a higher incidence of assymetry and can also cause unsightly scarring around the belly button.  My first choice is trans-axillary (through the arm pit), Dr Miller's is under the breast.  There are several reasons why I like the arm pit...one is that there is no scar on the breast.  I choose a small crease in the arm pit that is there in everyone and use it to make my incision.  This usually heals well within 6-12 months and you can barely find it....no scars on the breast and the scar that is there is concealed.  My second choice is the infra-mammary incision.  This incision is probably the easiest one to use as it is the least remote from where the implants are placed.  It is also a commonly used incision later if implants are replaced or any other work on the capsule is necessary.  The down side....an incision on the breast, even though they usually heal very well.

So don't forget to call 918-786-7780 or 1-866-weight0 to make your appointment.  With only a little over 3 weeks left, the time is now.  As long as you book before April 31, you can pick any date after and still get the special pricing.  Call TODAY!!

What does Bravo have to do with gastro-esophageal reflux disease??  Well, let's investigate it a little.

What is GERD (gastro-esophageal reflux disease)?? Here is a good definition: 

GERD is characterized by symptoms and/or tissue damage that results from repeated or prolonged exposure of the lining of the esophagus to acidic contents from the stomach and occurs when the lower esophageal sphincter (LES) does not seal off the esophagus from the stomach.

The two most frequently reported symptoms of GERD are heartburn, which can be described as a burning discomfort that begins behind the breastbone and radiates to the neck and throat, and acid regurgitation, which is characterized as a bitter, sour tasting fluid. One out of five people experience heartburn or acid regurgitation on a weekly basis and two out of five people experience heartburn or acid regurgitation at least once a month.

This is a good depiction of how reflux occurs.  The esophagus is not prepared to handle the exposure to acid that the stomach is.  The "heartburn" that can occur is normal on occasion, but if it occurs frequently, it can cause changes in the lining of the esophagus... esophagitis. Besides the symptoms this can cause, I.E. heartburn, chest pain, hoarseness, coughing, bad breath, inability to sleep, it can cause strictures in the esophagus, difficulty swallowing, and changes in the cellular lining that can be dangerous.

Fortunately, today, we have medicines that are very effective in reducing the acid and the symptoms that it causes.  These medications are readily available, even over the counter, but, they are not meant to be used for a long time.  They also have a dark side.  PPI (proton pump inhibitors) like prilosec, nexium, etc., when taken for the long term can cause calcium leaching from the bone leading to osteoporosis or thinning of the bones.  They can also cause changes in the lining of the stomach leading to polyp formation.  They can also be very expensive!!

So, what can be done about this!!  When I see a patient with symptoms of reflux, the first thing we like to do is document any changes to the baseline by looking with a scope...an EGD.  This allows us to look and biopsy to establish any changes.  The procedure takes about 15 minutes under sedation...pretty easy.  We then start a trial of medication which usually works.  It is recommended that the trial is relatively short...a few months...  If symptoms persist we will then schedule for a BRAVO pH monitoring test after being off of the meds for about a week.  This allows us to rule out other causes for the symptoms you are experiencing.  The Bravo is a small monitor that adheres to the esophagus for a few days and monitors the acidity.  You keep a journal of symptoms while we monitor...symptoms and acid=a positive test. 

With a positive test, changes in the esophagus, and symptoms on the medication, we recommend a laparoscopic repair.  This is called a Nissen Fundoplication (hiatal hernias are also repaired at the same time).  If the medications alleviate the symptoms, and you have been on them a long time....we have to decide if surgery is appropriate.  Considering the fact that the medications can cause problems, if you are healthy, patients usually opt for fixing the problem to get off of them medication.

The success rate for the Nissen is about 90%, as reported in the literature....there are not many treatments that have statistics that good!!  You will usually spend one night in the hospital and are back to normal in a couple of weeks with only small (1/4 inch) incisions.

So, the Bravo is a great test to help us figure out if the symptoms you are having are actually caused by your GERD....that's important.  The worst thing we can do is fix your reflux and later find out your symptoms are from something else!!

Come see us today if you have reflux that does not respond to medications, or, if you have been on the meds for some time and cannot live without them...WE can help.  We do EGD, Bravo pH testing, AND Nissen Fundoplication, Total Body Surgical!

Call 918-786-7780 or toll free 877-weight0 today for an appointment!!

Don't forget our special pricing on breast enhancement surgery until April 30..what a deal!! Just click on the breast button to see what it's all about.  AND our liposuction special pricing too, look great for summer!!  Cosmetic consultations are always complimentary!!

Boobs and Boats!!  Crass?  Shocking?  Well, it's not meant to be, but I sure got your attention, didn't I?  Here in Grove, we are welcoming the Bass Masters Classic this week, essentially the Super Bowl of fishing. With that, we are also having our annual boat show in town.  To many, boats means the lake, and the lake means sun and fun. 

 Summer fun!!

It seems that even though there was snow last week, Memorial Day is just around the corner.  Boats mean swimwear, sun tan lotion, strapless dresses and other summer wear.  This is the time many women think about breast enhancement.  That leads me to discuss our focus for the next 2 months: breast augmentation, AKA boob jobs.  Why are we focusing on this, you might ask??  If you didn't know, spring time is our breast enhancement special time.  Of course we are pretty affordable year round but in the spring, we pull out all the stops and try to make breast enhancement as affordable as possible. Hit the button below to get the details....

With a summer spirit in my mind, if you are considering breast enhancement, here are some things to think about. There are generally three categories women want to fall into after augmentation: 1) One that only the woman and her significant other notice. A very small change.  In this situation the desire is only improved shape and not necessarily size. 2) The second type is one where a difference is noticable but not over the top, enough to turn a few heads.  Essentially, enough to fill out a bathing suit, accentuate a nice summer top, or just make shirts fit better.  3) The third type is one that stops traffic.  Typically uncommon, we certainly try to  accomodate all wishes.  The bottom line, we want YOU to pick the size and shape that you feel most comfortable with.  Sure, we'll make suggestions, but ultimately, it is your body.  

The process is fairly straightforward.  After discussing with you what it is you are looking for, we will have you use a sizing bra, and place actual implants within it.  Bring your favorite top to try on over this bra if you like.  Take as much time as you need.  Once a size is found, we then discuss what incisions you'd prefer.  There are four types: through the nipple, through the armpit, through the bellybutton, and underneath the breast.  The nipple or peri areolar incision is not something that we recommend, as the scar is visible plainly when viewing the breast from the front.  Making the incision through the armpit hides the scar, but it can be a bit more painful than the other types on incisions.

 transaxillary incision

Placing the implant through the bellybutton has really fallen out of favor because the higher likelihood of abnormal implant placement, and the fact that silicone implants cannot be placed this way.  The incision made underneath the breast is well hidden, and the least painful.

  inframammary incision

We like placement through incisions under the breast or through the armpit but we can place them through any approach.  If an implant ever needs to be replaced in the future, it is always done through an incision at the bottom of the breast. Next, we discuss placing the implants above or below the pectoralis muscle.  When possible we like to place them below the pectoralis muscle.  It gives the implant more support, and looks more natural.  The best way to think about it is like a natural bra.  Placing the implant above the muscle has less support, and gives more of a "stuck on" appearance.  We place implants above the muscle when a breast is borderline needing a lift. Next, our consultation will turn to the type of implants.  We offer two types: saline and silicone.  Both have their positives and negatives which we will discuss with you at your consult.  It really boils down to personal choice.  The saline implants are a little bit cheaper in price than the silicone.  The feel of the two types is distinctly different. The saline feels a bit more like a water balloon, which is essentially what it is.  It's a bag filled with salt water.  The silicone feels a bit more like actual breast tissue. 

http://youtu.be/kceaEMmi7pA (video showing the inside of a silicone breast implant)

The leak rate of saline implants are a little higher than the silicone implants- there is a 2% chance per year collective risk of having a leaking implant.  That means, at 2% a year, over 50 years, there would be a 100% chance that your saline implant would leak (50 yrs x 2%= 100%).  If a saline implant leaks, it is obvious.  It's a bit like having a flat tire on your car.  The saline that leaks out is easily absorbed by the body (55-60% of the body consists of saline already!). 

 http://youtu.be/ILWdCJNSTeI (here is a discussion about silicone implants)

If you wake up with a deflated saline implant, you call us, and within a very short period of time, it is replaced and you are back to normal.  If the implant leaks due to a defect, it is replaced under a warranty.  Silicone leaks can be a bit more difficult to diagnose. Wrinkling or rippling that can be seen on the sides of the breast has a higher incidence with saline implants.  What do I mean by rippling? 

 breast implant rippling

Have you ever been to the beach or swimming pool and seen a woman lean over, and the sides of her breasts have ripples in them?  That is from the native breast tissue thinning out, and the ability to see more of the actual implant.  This problem is a little more common with saline implants but can occur with either type.  It occurs more frequently in very thin patients with low body fat and large implants. 

We will be talking about implants for the next few weeks so stay tuned.  Remember that if you are coming from out of town you can email us through the contact form and we can do a great deal of the work, getting you ready here.  You come to the office close to the day of your surgery and it saves you time.  Remember this special only lasts until April 30 so you must act now!!  Call 918-786-7780 today to reserve YOUR time!!

Everyone wants to know about silicone implants so I decided to talk about them this week.  Silicone implants were the first mainstream implants for breasts available to the US market.  They were used for years and for the most part, the results were good.  Most were placed above the muscle through a variety of approaches.  However, there were design flaws in the implants themselves that led to a number of suits and settlements that actually put a few manufacturers out of business.  The suits claimed that a number of illnesses (cancers, fibromyalgias, lupus, and many other problems) were caused by the silicone.  The fact is, the more liquid silicone in the old style implants leached out over time through the capsule.  This silicone was picked up in the lymphatic system and traveled into lymph nodes and other areas of the body.  Because of litigation and fear, the FDA removed the implants from the market in the early 90's.  The FDA authorized several companies to perfect and study silicone implants at that time. 

Improvements that were made were basically to the capsule holding the silicone and to the silicone itself.  The silicone was heavily cross linked to create a jelly-like substance that likes to stick together.  When a hole is poked into the implant, the silicone does not flow out like liquid.  It takes a fair amount of pressure on the implant to extrude the silicone.  The implant can actually be cut in half....the video I made below demonstrates this.

http://youtu.be/kceaEMmi7pA

The benefits of silicone are somewhat subjective.  First, they are perceived by some to feel "more natural".  Second, they have a tendency to ripple less.  A photo of rippling is below.  Although rippling can happen with silicone, it occurs less frequently.  Silicone is a lower pressure implant and that is why.  Because of this lower pressure, the upper pole is not quite as full as with saline and can look less like an implant.

The down side to silicone implants is expense.  They do cost more...about $1200.  The incidence of capsular contracture (when the capsule the body makes around the implant becomes tight and makes the implant feel hard) is higher...not a lot higher, but higher.  Women under 22 years of age do not qualify for silicone because of FDA rules.  If they do rupture, it can be difficult to detect and the FDA recommends periodic MRI of the breast for detection, however, even MRI is not that great. 

Watch this video where I cut a new silicone gel implant in half.  You can see the properties of the silicone.

I personally have no preference between silicone and saline.  I do not like high profile saline  implants because the look is not appealing.  If someone wants implants under the breast instead of under the muscle, I recommend silicone.  Otherwise I think they are interchangeable.

Hope this answers a few questions for you.  Don't forget our specials on implants for this spring.  We have great pricing that is hard to beat...call us at 918-786-7780 for details.  We also have pricing on laser hair removal that I defy anyone to beat....$50 per treatment per area....wow!!

Talk next week!!

 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 am writing on liposuction today to introduce a fall pricing reduction at Total Body Surgical!  We are pros at this procedure and NOW is the best time to do it.  Why??? Well, liposuction does take some time to completely heal and "stabilize".  Getting ready for next summer starts today!  I have extensive training and experience with all types of liposuction and not to toot my own horn....am pretty good at it!

Liposuction has been around for a long time.  The first procedures were deadly in fact.  It was rediscovered and refined later but still often required blood transfusion and hospitalization.  Due to the work of Dr. Klein (a dermatologist), new and better transformations in the procedure now make it safe and more effective for the right people. 

Who are the right people you might ask.  Liposuction works best for those who are "in shape" but have problem areas.  A chubby tummy, hips or love handles, saddle bags or outer thighs, inner thighs, chest, arms, or neck.  Liposuction IS NOT a weight loss procedure.  For those with smaller areas that they just cannot get rid of, liposuction is a procedure you should consider.

Modern liposuction can usually be done in an office procedure room.  We use sedation and tumescent fluid so that you can come and go the same day.  Tumescent fluid is the key to limiting pain and blood loss.   The technique, developed by Dr. Klein, is based on good science and is very safe when done properly.  The fluid is made using lidocaine (a local anesthetic), epinephrine (a normal chemical in the body that causes blood vessels to constrict or get smaller), and saline (salt water in concentrations that occur in the blood).  After marking the areas to be treated and sedation, the areas are injected with this fluid.  This causes the blood vessels in the area to constrict and numbs the area thus markedly limiting blood loss.  The areas fat is then removed with a small hollow tube.  This is done very carefully to not leave any defects or dents.The channels of fat removed shrink with time and the area smooths and recontours.  Without the fat!  Vaser and Laser liposuction are technologies that are used to heat the skin so that it shrinks to fit the smaller size of the underlying fat pad.  In my experience, using these technologies alone, without revoming the fat, does not give satisfying results and recovery times are about the same....a few days, then soreness for a couple of weeks.  The fat that is injured during the procedure and not removed is absorbed by the body.

The complications that can occur are:

-lumpiness (usually occurs if weight is gained after liposuction)

-bruising (resolves with time)

-sagging skin (the one variable that cannot be controlled.  Usually not a problem if the areas are selected appropriately)

-hyperpigmentation (especially in ethnic skin)

-dents (occur by removing too much fat in an area and can usually be repaired with revision)

Deaths can occur and are discussed by the media at length.  These usually occur when inexperienced physicians give too much lidocaine.  We are very meticulous about the dosing and when done properly, lidocaine toxicity is very rare.  However, any cosmetic procedure can have REAL complications and should not be taken lightly!  That's why I only do liposuction in the office on healthy individuals. I see patients personally, evaluate them, discuss the procedure's risks and benefits, and if I feel it is not the procedure to give you the results YOU desire, I will tell you.

Please go to my portfolio page to see some of my results and click on the picture or button to see our exclusive pricing on liposuction.  ACT NOW as this is a limited offer!!  Call 918-786-7780 for a complimentary consultation or fill out the contact form and we will call you....I look forward to meeting you!!

Onchomycosis, also known as nail fungus, is a very common problem.

It is a problem that can make people very self conscious and is often very difficult to treat effectively. The cause is a fungus called tinea unguum.  The fungus infects the nail bed where it is protected, moist, warm, and has a good supply of food.  Common risk factors for fungal infection are:

• Getting manicures and pedicures using utensils that have been used on other people

• Getting minor skin or nail injuries

• Having a nail deformity or nail disease

• Having moist skin for a long time

• Poorly functioning immune system (Diabetes and smoking)

• Wearing closed-in footwear

Symptoms

Nail changes on one or more nails (usually toenails):

• Brittleness

• Change in nail shape

• Crumbling of the outside edges of the nail

• Debris trapped under the nail

• Loosening or lifting up of the nail

• Loss of luster and shine

• Thickening of the nail

• White or yellow streaks on the side of the nailThese changes in the nail are unsightly and can lead to discomfort, and to the inability to wear certain footwear due to the thickness of the nail.  Until recently, the problem was very difficult to treat.  Creams, vinegar, nail removal, were the only options.  Then came oral medications:

Over-the-counter creams and ointments generally do not help treat this condition.

Prescription antifungal medicines taken by mouth may help clear the fungus.

• You will need to take the medicine for about 2 to 3 months for toenails; a shorter time for fingernails

• Fluconazole griseofulvin, terbinafine, and itraconazole are used to treat this condition.

• Your health care provider will do lab tests to check for liver damage while you are taking these medicines.

In some cases, the health care provider was required to remove the nail. Nails grow slowly. Even if treatment is successful, a new, clearer nail may take up to a year to grow in. AND the treatment effectiveness is only about 50%.

So why am I writing this???  Well, there is a new treatment that is being used that is about 80% effective and I can give it to you.  NO blood tests, NO risk of liver damage, NO anesthesia, NO pain.  Also, very quick and usually only takes two treatments.  It is done using FDA approved laser treatment. 

The treatment is done in the office and takes about 15 minutes.  We use a 1064 YAG laser that warms the nail and kills the fungus.  We treat all 10 toes and repeat the treatment in 6 weeks.  Usually the nail re-grows and looks normal in 3-6 months.  NO anesthesia is required and can be done on the day of your first visit is you schedule.  If more than 2 treatments are required, the cost is greatly reduced.

The expense of the medications and lab work required could exceed $1000.00 and, again, was only 50% effective.  The laser treatment for all toes, both feet, two treatments is $800.00...very affordable.

Book your appointment today and tell them it is for treatment of nail fungus so we can schedule laser time.  We will have you back in open toed shoes or sandles before next summer!!!  Call 918-786-7780 or fill out the contact form and we will call you!

Don't forget out lap band special AND we are starting a new liposuction promotion until Christmas...get one area 10% off and get a second smaller area FREE!!!                          

Click on image to see lipo special offer!

For the last installment on veins in this series let's discuss the pesky spider vein.  These veins are very common and can be unsightly.  I probably hear more complaints about spider veins than any other vein problems.  They can occur in young women, old women, and every age in between.  The cause of these veins which occur superficially in the skin is usually hereditary and they are aggravated by standing for long periods.  They can occur alone or may be associated with a bigger underlying vein issue.  The reason they enlarge and become visible is increased venous pressure.  Good news is, when these veins occur, they can be treated. At Total Body Surgical, we have a number of methods for treatment.  First, if the problem is extensive, we go out of our way to ensure that the cause is not just a symptom of an underlying bigger vein problem.  At the Total Body Surgical Vein Center we use ultrasound to make sure the larger veins are healthy.  If the spider veins are limited, or if the larger venous system is healthy, we then focus on the cosmetic treatment of the spider veins themselves.  Dr Swetnam usually uses sclerotherapy to eliminate them.  This is a minor procedure that is performed in the office.  It is fairly quick and with minimal discomfort.  A solution is injected into the spider vein that causes inflammation of the lining of the vein, eventually causing your body to remove it so that it can no longer function, or be seen.   This may take a few treatments and requires the wearing of compression stockings for about 2 weeks after injection and avoidance of strenuous exercise and hot tubs for that time as well.  In some instances, some brownish discoloration can occur around the site that usually resolves.  Some ulceration of the skin can also occur which heals well but can cause some minor scarring.  If the larger veins are diseased and the spider veins are injected, they will recur.  If we do a diagnostic ultrasound that shows the larger veins are not functioning, we treat those first with laser closure.  This stops the pressure and then allows us to treat the smaller veins with sclerotherapy successfully.I also use the Vein Light to isolate the "reticular" or connecting veins that feed the spider vein.  This allows me to see what is feeding the group of spider veins and inject it as well. 

For much smaller areas I sometimes will use the YAG laser to close them.  This is relatively quick.  I also use the laser when treating facial veins.  These commonly occur around the base of the nose, on the cheeks and chin.  They are very common in people with rosacea. 

Treatment of spider veins is an ongoing process and should be maintained.  Most people with significant spider veins will eventually meet criteria for treatment of the larger veins that are the root of the problem.  Patients with facial veins will also need maintenance.

Next week....fungus amungus.....the newest treatment for toe nail fungus!!!

Keep an eye out for new specials for fall!!!!

Come see us at Total Body Surgical for Obagi products, Skinceuticals, Botox, Juvederm, and all laser services.  Coming soon....laser tattoo removal!!

918-786-7780

Over the past few weeks (with the exception of Butts last week) we have been talking about weight loss and surgical options.  This week I would like to start the discussion on what to do AFTER losing all the weight.  I guess the first question is....who qualifies to have post bariatric body contouring??  Well, first of all, you must be healthy enough for elective surgery.  This means that your medical conditions, if you have any, should be well controlled. I think it is a fairly well known fact that most insurances will not pay for this type of surgery so I wouldn't expect it.

Hypertension, diabetes, heart disease, renal and others should be stable.  Fortunately, after massive weight loss, many of these problems are cured as the weight falls off.  The second thing that cosmetic surgeons consider is the stability of the patients weight.  My rule of thumb is a stable weight for a minimum of 12 months.  In other words, after weight loss surgery, we usually don't perform any body contouring until the weight loss has stopped and a stable weight has been maintained for a year.  This helps us avoid performing surgery more than once or getting results that are less than expected.  Since most patients are spending their hard earned money for these procedures, this precaution is usually appreciated.  One problem that weight loss patients struggle with is their new body image.  Once the weight starts to fall, the skin, which has been hopelessly stretched, does not return to its normal position and begins to hang.  As this occurs, patients have a tendency to become impatient with the process and want it removed.  It is my job to encourage patience with the process and wait until the weight has stabilized.

The next step is planning.  I like to start with a wish list....what bothers you about your new body sort of thing.  Depending on the amount of weight lost, this can be a very long list.  It also depends on how an individual loses weight.  This can be different for each person.  This is why there is no cook book remedy for everyone and procedures are personalized. 

The procedures that are requested are numerous and will be discussed in coming weeks.  Next week we will start with the most common procedure, the tummy tuck or abdominoplasty.

  Last week on the Total Body Surgical Cosmetic Surgery blog we talked about wrinkles and how good skin care and Botox can make a big difference.  This week we will take a look at the common fillers that can be used.

Below is one of the commonly used scales to measure and quantify the severity of wrinkles and skin damage.

Class II we would usually use Botox or Dysport because slowing the underlying muscles will usually eliminate the wrinkle as long as it is maintained.

Class III wrinkles will usually require "filling" as they are present at rest and are more or less permanent fixtures.  Filling them will not remove the wrinkle 100% but will go a long way toward making them tolerable.

There are many fillers on the market and thank goodness most of them now last a year or more.  This is in contrast to only 5 or 6 years ago when a filler would work for 2-4 months.  Many techniques can be nearly peramanant.

Hyaluronic acid fillers such as Juvederm and Perlane are great all around fillers that can be used nearly anywhere in the body.  This is because it is a naturally occurring substance in the body and is colorless.  They cause very little collagen production and the newer ones contain lidocaine which is a nice plus for the patient and injector.  These are the most widely used products.

Radiesse is another filler that is made of small calcium hydroxyapetite beads in a sugar based carrier.  This filler is limited in its use and should not be used in the lip or superficially anywhere.  It is great for larger volume fills in the cheek and nasolabial fold.  It works by causing your body to form collagen in the treated areas. It should last 12 to 18 months but will need some supplementation in that time.

Other common fillers are Sculptra which is poly L lactic acid can be used to create volume in the cheeks but this is a much slower process than the other two.

More permanent fillers are fat and silicone.  Fat harvesting and grafting has become common all over the body, but is very popular in the face.  Fat is harvested, treated and placed in areas where fat has disappeared over time.  There is some variability in the percentage of the fat that lives and therefore the procedure may need repeating. Lastly, silicone.  Silicone has received a bad name.  There are countless examples of low grade silicone used in too large a quantity to create a terrible result.  At Total Body Surgical, I have a great deal of experience with silicone.  We use only the best quality silikon 1000 that is manufactured by Alcon and made for use in the eye.  It works great for augmenting lips, filling areas of imperfection on the nose, and some acne scarring.

Next week....we'll address pigment issues!!  Come see us at Total Body Surgical.  Mention this blog and get $10.00per unit botox....That's a good price now!!