Total Body Surgical Blog

Re-do what?  I have lots of patients that ask about how long a cosmetic procedure will hold up or "last".  I think that is a fair question in most instances.

First, the face.  When people ask me the question before a facial procedure, the analogy I like to use is daylight savings time.  When you have a facial procedure, basically, we are resetting the clock on your appearance.  You will continue to age, just like time continues to tick away in daylight savings time.  In other words, the change is permanent, but aging continues to change your appearance.  The procedure most often repeated is eyelid surgery.  Eyelids move constantly, the skin is very thin, and the eyelid skin is exposed to a great deal of sun.  The nature of the skin is to stretch and when used a great deal, it will stretch more.  Upper and lower eyelid surgery, the second time, is usually less traumatic than the first time because the fatty tissue has already been removed.  That means that only the skin is removed in the second procedure.  The second procedure most often repeated is the facelift.  Again, after the first procedure, as we continue to mature, the skin continues to stretch and the floppy neck or jowel may return after 15-20 years.  A second face lift is easier because of scar tissue that forms gives us more tissue to work with so sutures hold better and dissection is less involved.  The procedure that holds up the best is the endoscopic brow lift.  Since the low brow is usually heredity related, once the brow is lifted it tends to stay put.

Second to discuss are body procedures.  Tummy tucks seldom need re-doing unless you have severe changes in weight or have a pregnancy after the initial procedure.  That is why we encourage women to be done reproducing before considering a tummy tuck.

The same is true of most other body procedures, thigh or butt lifts, arm reductions, etc.  Liposuction is seldom repeated in the same area except for touch-up prodedures since most of the fat cells in that area have been removed.  Of course, if you do gain weight, it will appear in other areas and the repeat procedure will be in that area instead of the old site.  In other words, if you have your abdomen done then gain 20 pounds, you may notice that your arms or thighs are where the weight is going.  The reason is, the fat cells that used to store fat in the abdominal wall are gone or greatly diminished in number and fat can no longer be stored there...it must go somewhere else.

The third is the breast.  This is a whole other animal sorry to say.  The breast is somewhat unpredictable.  For breast augmentations, they look great in younger women and generally hold up well with two caveats....pregnancy and weight changes.  Most women look fantastic with their breast implants... until pregnancy.  Then, in some, the wheels come off.  The breast inlarges during and after pregnancy, breast feeding occurs, and for some, the process repeats itself over and over.  After several pregnancies and several years the breasts start looking sad.

They droop over the implants or sometimes take the implants with them.  In these cases, the only solution (after a tubal or vasectomy) is a breast lift, removing the old implants, and deciding whether to replace the implants or not.  The only way to get fullness in the upper part of the breast in this situation is with an implant so it just depends on the final outcome you are looking for.  Of course implants can always be placed later.

Hope this helps answer your questions and don't forget all of the special pricing we have going on with hair removal, tummy tuck, and weight loss surgeries!!

Call for complimentary cosmetic consultation 918-786-7780 or 1-877-weight-0.  We can't wait to hear from you!

Tired of hearing about the breast???  This week I want to talk about the less than perfect breast that some women develop.  I know many of you women are tired of hearing about the perfect breast that is just a little small and can be made better by implants.  What about the breast, due to genetics, or abnormal development, cannot be helped by implants alone??  Let's talk about that today to give you a break!  However, I don't want you to forget about our breast enhancement special...it only lasts until April 30 so you have to act quickly.  Click the button below to get the details!!

Let's see how the breast develops normally, then we'll have a better appreciation for how these deformities can occur.  Then we will cover how we fix them to make the breast look more normal.  The normal breast is stimulated to form by female hormones that begin production at menarche or the start of menstruation. The picture below shows the normal progression of the breast as it grows from a bud that men AND women have.  Again, it is the female hormonal soup that causes them to form.

Of course it is very rare for both breast to form exactly the same.  Perfect symmetry in the body is rare, so each breast is different, even in the same person.  This is why some women have difficulty finding a properly fitting bra.  There may be a half cup difference between sides.....this is not abnormal....just aggravating!  Here is a picture of different breast shapes and sizes.  This does not include all types of course, but it gives you an idea of how many variations of normal there are and also includes some of the abnormal breast shapes.

 (the "perfect" breast shape is a misnomer of course)

As you can see from the first picture, the breast bud starts first and develops concentrically, widening to form the breast mound.  If this concentric expansion is retarded, the breast forms as a tube, making the very constricted and abnormal looking.  The function of the breast is also retarded and in most cases, breast feeding later in life is not possible.

 This picture is a depiction of tubular breasts of different severities.  It is the mound of the breast that is constricted and does not spread out, therefore, the tubular shape of the breast. 

The other feature of the tubular breast deformity is a herniation of the nipple.  Normally, as the nipple and areola develop, they are "puffy".  The nipple is puffy until the breast mound spreads out.  As this happens, the nipple-areolar complex flattens to create the more "normal" appearing breast as a whole.

 Herniated "puffy" nipple.

So now that we know what a tubular breast deformity is.....what can be done about it?  To fix this problem properly, we must address several issues.  First, is the nipple herniation.  Fortunately, fixing the nipple also gives us access to the rest of the problem and allows the entire fix to be done through one incision.  We use the peri-areolar incision to make the nipple smaller and to allow access to the tubular, constricted, breast tissue below.

 This incision allows us to reduce the nipple size and when closed it flattens the nipple and areola into a more normal appearance.  The constricted breast is broken up below so that it is no longer in a tube shape and lays flatter. 

The last step is augmentation.  Since the breast only formed centrally, there is generally very little volume.  This can only be corrected by adding volume with an implant.  We place the implant below the muscle and through the same incision.  Saline implants or silicone implants are used as there is no difference in the result...again...it is personal preference.

The results are generally very good.  It does take some time for the skin to stretch and accomidate the new volume.  There also may be some creasing of the skin, usually the lower part of the breast, due to its tight adherence to the chest wall, that may take some time to stretch.  This skin may never stretch fully.  The goal is to get as near a normal appearing breast as possible.  This is not always achievable but any improvement is usually greatly appreciated.  The incisions heal nicely and the recovery time is about that of a breast augmentation.

 Good representation of tubular breast deformity repair.

Come see us today for all of your Cosmetic surgery, Vein surgery, Obesity surgery, and General surgery needs.  All Cosmetic Surgery Consults are complimentary, call 918-786-7780 or call toll free 1-877-weight0.  Be sure to take advantage of our breast augmentation special through April 30!!!!!

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

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

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

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

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

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

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

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.