Total Body Surgical Blog

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

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

What is a gallbladder???? 

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

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

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

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

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

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

New blogs starting after the new year.

Let's hope 2012 will be a great one and that things actually do "change".

Look for some of the same offers this year AND some new ones.

Thank you all for making our year a very good start here in Grove.

Last week we discussed more common general surgery procedures that can be performed with Cosmetic procedures.  What else can be done???  It is hard to come up with a complete list there are so many. 

Here are some suggestions:

Many people have a fear of needles.  While anesthesia is administered for other elective surgery, it is a great time to place dermal fillers in the nasolabial folds, marrionette lines, or even augment the lips.  Of course Botox can be injected as well.

More substantial procedures can be done as well.  Breast augmentation can be added to elective laparoscopic procedures such as laparoscopic cholecystectomy, small laparoscopic hernia repairs, many gyn procedures and so on.  Of course if the primary procedure is being done due to infection or obstruction or other serious illness, this is not possible.

Laser skin resurfacing can be done while under general anesthesia for non-emergent procedures as well.  This allows the procedure to be done without the discomfort sometimes associated with resurfacing.  Light therapy for sun spots or closure of facial veins can also be done.

Arm reductions, small area liposuction, face work, injections, laser work, tummy tucks, breast augmentation can all be added to general surgical procedures when the procedure is purely elective. 

What are the advantages of combining procedures??  As we discussed last week, the advantages are many.  First of all, a single anesthesia is very advantageous, lowering risk by limiting the number of anesthetic exposures.  Secondly, a single surgical recovery is much better than multiple ones.  The recovery is simultaneous.

There it is, short and sweet.  Procedures can be combined if desired and safe.  Come see us at Total Body Surgical and we can discuss what is possible.  Call 918-786-7780 or fill out a contact form and we will call you!  Don't forget our special pricing on liposuction, lap bands, nail fungus, and fillers.

We are also planning Botox events in Grove and in Tulsa this month to be ready for the holidays.  Special pricing will be offered at these events.  Sign up using a contact form and we will inform you of the dates and times....or you can call.

More next week!  Oh, and like us on facebook!

I here it all the time....if I had only known, I would have had a tummy tuck when I had.....fill in the blank.  I must say that one of the great things about having experience and credentials in two fields (General and Cosmetic Surgery) allows me to offer a number of options that many cannot.  Of course Cosmetic procedures can be combined.  We do it all the time...tummy tuck with liposuction....face lift with eyelid surgery....tummy tuck with breast lift or augmentation....and the list goes on.  I will usually combine procedures as long as it takes less than around 4 hours.  I feel that this is a safe limit for anesthesia and for me this is about the limit of concentration for me and the surgery crew.  If I think adding procedures can be done in this time limit and it makes sense, we can do it.  If not, we divide the procedures into different days.
But what about combining cosmetic and Non-cosmetic procedures??  At Total Body Surgical we do them all the time.  It saves time and money for our patients.  One anesthetic and one recovery period gets people back to normal quickly instead of doing both twice.

The most common combination is a hysterectomy and tummy tuck.  This is an ideal combination.  The incision for a hysterectomy is low and transverse in the abdomen.  The tummy tuck incision is in the same area.  Hysterectomies are usually a fairly quick procedure and when combined with a tummy tuck the 4 hour time limit is more than enough time to do both, with considerable time to spare.  At Total Body Surgical we enlist (or are enlisted by) the OB/GYN surgeons Dr Thomas or Dr Dietz.  Most women having hysterectomies have had one or more children with the common pooch, stretch marks, and loose skin that goes along with it.  It is the perfect combination....one anesthesia....one recovery.

The second most common is hernias and a tummy tuck.  Many people have belly button, inguinal, or incisional hernias that need to be fixed.  These repairs can be done in conjunction with a tummy tuck very easily.  Depending on the size and location of the hernia I can either fix it laparoscopic or open.  The incisions are not made through the skin as the skin is moved out of the way during the tummy tuck.  The repair can be done with mesh if needed and AGAIN, one anesthetic and one recovery period!! 

The third procedure is the cholecystectomy.  The most common general surgical procedure can easily be done in conjunction with a tummy tuck.  The skin is moved as with a normal tummy tuck, then the gall bladder is removed through laparoscopes and the tummy tuck is completed.  There is no sign of the procedure afterwards and only one anesthetic and one recovery. 

Procedures that do not fit with cosmetic surgery are bowel surgeries.  These procedures are "dirty" procedures by nature due to bowel contents and just don't fit due to infection risks.

Sooo, if you were thinking about a tummy tuck and then had the bomb dropped that you also need a cholecystectomy or hysterectomy or hernia....come see us at Total Body Surgical and we may be able to save you time and money.  Check our portfolio page and see if you can pick which tummy tucks were combined procedures....there are some!!!

Call 918-786-7780 or fill out a contact form and we will call you.  Don't forget our special offers on liposuction, treatment of nail fungus, lap bands, and fillers.  Please feel free to write comments or suggestions for other blog topics AND like us on FB!!!

Since there have been no requests about special interests, I get to choose!!  The next few weeks I will address veins and what to do about them.

The reason Cosmetic Surgery and Vein Surgery are so intimately associated is quite simple.  I can liposuction, augment, and tuck everything to make the body look great, and yet, if your legs look like this.....

it makes it hard to wear a dress, shorts, a swimming suit, or any other attire. 

Vein disease or chronic venous insufficiency, is a common problem.  It is thought to effect at least half of the population to varying degrees.  It is thought that the problem is hereditary, but can have other causes such as trauma or thrombosis (clotting).  The veins causing the problem have valves in them that no longer work properly.  The muscles of the lower leg act as a pump to move blood up the veins as they contract.  The valves are supposed to allow the blood to travel towards the heart but not let it return down the leg.This picture illustrates normal valve activity.The second image shows a comparison of normal with abnormal function.  When these valves are defective, the blood is allowed to return down the leg, increasing pressure and causing tributaries to dilate and become tortuous.  Spider veins also develope as the pressure causes enlargement of smaller veins in the skin.  The disease is not limited to appearance either.  This process causes cramping, restless leg syndrome, skin discoloration, rashes, ulceration with secondary infection, swelling, and ultimately, disability. 

The reason that these problems happen is multifactorial.  Pressure, low oxygen tension in venous blood, and the leaching of iron products from the hemoglobin in the blood and into the skin.  Depending on the severity of the reflux these symptoms may occur early or late in life.  

I hope this discussion helps shed light on why venous problems develope.  Over the next few weeks we will dive into the diagnosis and treatment of chronic venous disease. 

What's the point???  Well, there are several.  This week I would like to summarize the past several weeks.  As obesity becomes a growing world wide problem, obesity surgery is becoming a common thing.  The common procedures are the Lap Band, the gastric sleeve, and the Roux en Y bypass.  They all have their place in the treatment of obesity.  As the procedures and massive weight loss occur, the desire and need for body contouring increase.  If you did not see the previous installments, go check them out to see what procedures are most common and in greater detail.  This installment will cover some of the high points of more detailed discussions of weeks past.

1.  Your weight should be stable for a minimum of 12 months.  Lose the weight, get where you want to be and stay there for at least 12 months before having surgery.  Doing it this way gives better results and leads to fewer repeats.

2.  You must be healthy.  Cosmetic surgery is not "minor" surgery.  People can have complications and even death from this type of surgery.  Make sure you have a healthy heart, lungs, kidneys, and that diabetes and hypertension are controlled prior to your surgery.

3.  You cannot have it all done at once.  These surgeries can be very taxing on the surgeon and you.  Sit down and figure out, in order, what bothers you the most.  Then discuss with your surgeon a strategy to attack the areas in a planned way that makes sense and is safe.  Sometimes procedures can be combined but don't get in too big of a hurry, be safe.

4.  Know what is available.  The most common procedures I see, in order, are:

-Tummy tuck

-Breast lift

-Arm reduction

-Butt lift

-Face lift

-Thigh lift

-Back lift

5.  Seek out a safe and well trained professional....nuff said.

Hope this helps.  New topic next week.  If there is anything you would like to hear about, drop me a line, jeffswetnam@yahoo.com and I will try to address it.

Thanks for tuning in and don't miss our specials.  New ones coming for the fall to so keep looking here.

For the last installment on massive weight loss, we will look at the face. Massive weight gain can cause unrecognizable changes in the face.  The neck, cheeks, and chin become stretched with fatty deposits and cause skin changes that may be permanent even after weight loss.

For the lucky few, facial skin will shrink back to its near normal state.  In these cases, nothing is needed.  For the most part, however, what we see is skin that sags in the neck area and jowl formation in the lower face.  Wrinkles may also appear in the cheek area and in the mid face we see volume loss that creates that "tired" look.  In people that lose massive amounts of weight, these changes can occur regardless of age.  When weight loss patients present, they usually have numerous areas of concern and I try to help them prioritize because we cannot do all procedures at once.  Some want their face fixed first, some don't, again, it is a matter of priority.

The only way to gain long term results in recovering a youthful face are lifting procedures.  We devide the face into three main areas. 1. The lower face and neck. 2. The mid face. 3. The brow.  A fourth area would be the eyelid that I will talk about in a later blog.  

The lower face and neck lift.  This procedure addresses the excess neck skin, jowling, and wrinkling in the cheek area.  Sagging skin in these areas can be very pronounced after massive weight loss.  Incisions for this procedure are placed around the ear   and a small incision under the chin.  The arrows show the direction of pull on the skin and the underlying muscle.  If the neck is not lax, a mini face lift (s-lift, lifestyle lift, day lift, etc.) can be done which shortens the incision to the front of the ear and only partially up the back of the ear.

The brow, when sagging, can cause visual problems and most notably can cause wrinkling in the forehead because of continuous muscle contraction as your brain lifts the brow.  For the most part, I use the endoscopic approach to lifting the brow.  This is done through small incisions in the hair that are essentially invisible.  The brow is lifted and anchored.  After doing this procedure, the forehead becomes smooth and the hooding over the eye is gone.

The face lift and brow lift can be done simultaneously if desired.

For the mid face, the problem is usually loss of volume and a hollow appearance develops.  I feel the best way to remedy this problem is by replacing this volume.  This can be done in several ways.  The shortest lasting way to do this is with a filler product.  The volume is placed over the cheek area.  The second best product is fat.  The fat is harvested from the hip or abdominal area and transplanted back into the face rejuvenating the mid face.  The longest lasting way is with implants.  These are solid silicone, pre-formed devices that replace the lost volume in the area.

These three procedures are the ones most commonly used to treat and rejuvenate the face after weight loss.  Not everyone fits the usual mode however, and consultation to figure out the best treatment for you is essential.  Come see us at INTEGRIS Total Body Surgical for a complimentary cosmetic consultation.

Don't forget our breast and lap band specials that are still going on. Act now to take advantage of great savings!! 

To continue the conversation about body contouring after weight loss surgery, this installment will address the thighs and knees.  After the weight loss, the tummy tuck, the arm reduction, the breast lift, and the butt lift, many people are ready to address the thighs.  You may not need all of these procedures, you may only need one or two.  If more than one procedure is required, I usually save the thighs for last.  Why??  Well, to be honest, it is a difficult recovery because of where the incisions must be placed.  Do you need a thigh lift, or will liposuction cure the problem?  It depends on the amount of extra skin that is present.  Too much sagging skin will not contract with liposuction and will need to be removed.  A problem area of fat depostion can be liposuctioned. 

Incisions for a thigh lift are in the groin, following the contour of the upper thigh.  To lift the knee, the incision travels down the inner thigh, making a kind of "T".  Removing this skin allows us to make the thigh tighter and removing the skin in the groin allows us to pull the skin up getting rid of the sagging and re-shaping the thighs.  The incisions are placed in a high motion area that stays moist and is close to areas that can be difficult to keep clean.  These factors can make wound healing a challenge in the best of circumstances.....thigh lifts are not for the faint of heart.  They can, however, make a huge difference in appearance and wardrobe. 

Come see us at Total Body Surgical for all of your body contouring needs.  Time is running out to take advantage of the Breast and lap band specials so don't miss them!!

More next week.

What about butts after massive weight loss?? 

Many changes occur after weight loss.  We have been discussing arms, abdomen, breast and when to proceed with these procedures after weight loss or weight loss surgery. 

The problem with massive weight loss is that protein stores in the body are consumed after sugar and before fat.  We all want to lose the fat first but this is not generally what happens.  Fat is the bodies way of long term energy storage and is mobilized only after other sources are used up or low.  In massive weight loss, especially after bypass surgery, muscle protein is mobilized as the weight loss proceeds.  One of the biggest muscles in our bodies is the muscles in the butt.....the gluteal muscles.  Think about it....these muscles are the lever that allow us to stand, walk, use stairs, etc., it is not just a seat pad!!  As weight loss proceeds, this muscle gets smaller as protein is mobilized and used for energy.  As this occurs, of course, the skin sags and the butt ends up on the upper thighs.  Many people want their butt back to its original position.  The way we put it back is with the butt lift.  It is similar to a tummy tuck for the rear end.  The incision is placed along the upper Gluteal region and the skin is lifted up to remove the excess.  In some instances an implant can also be placed to give more volume to the butt.  The one pictured here has had a previous tummy tuck as well.

Come see us at Total Body Surgical for all of your after bariatric surgery needs.  Also, don't forget our breast augmentation and Lap Band special pricing....time is running out so ACT NOW!!

I will continue to discuss procedures that are common after weight loss surgery.  The most common is the tummy tuck which was discussed in previous blogs and breasts are probably the second most common area addressed in women. 

The reason breast take such a beating after significant weight loss is that breasts are about 80% fat to begin with.  It follows that when women lose a large amount of weight, what is lost is fat and muscle.  The skin of the breast is "deflated" and what actual breast tissue remains hangs in the deflated skin....Rocks in Socks.

The objective when reconstructing the breast is to reposition the nipple and areola and if desired, refill the breast envelope.  There are options when rebuilding the breast.  One option is to lift the nipple and remove excess skin only.  This choice is certainly acceptable but does not give the fullness in the upper breast many want.  To get this, an implant must be used.  The incisions for reconstruction of this type vary based on the distance the nipple must be moved above the lower fold of the breast.  Usually the incision is an anchor type incision, around the nipple, a vertical and a horizontal incision below.  The nipple is not removed, just moved on a pedicle into its new position.  Breast skin and tissue is removed to reshape the breast.  An implant adds fullness to the upper aspect of the breast.  The implant can be placed at the same time.

Come see us at Total Body Surgical and take advantage of the specials above!!