Aesthetic Surgical Images

Are There Complications that Come with a Mommy Makeover?

2015-04-21T11:33:00.001-07:00

The mommy makeover is one of the most popular operations performed by plastic surgeons. The procedure is a combination of cosmetic breast surgery, liposuction, and abdominoplasty. It has been designed to correct changes that occur normally with pregnancy.

Although the procedure is considered to be extremely safe, complications may occasionally occur. These include bleeding, hematoma formation, loss of tissue, wound breakdown, excess scarring, infection, asymmetry and numbness.

Several steps can be taken to minimize complications. These include utilizing an accredited outpatient surgical facility, a board-certified plastic surgeon and a board-certified anesthesiologist. Although, these steps won’t totally eliminate complications, they will hopefully decrease the incidents.

Breast Augmentation through the Belly Button

2015-04-15T11:58:00.003-07:00

The transumbilical approach to breast augmentation has advocates, but the vast majority of plastic surgeons prefer other surgical approaches. Surgeons, who prefer the transumbilical approach, feel that this procedure has a major advantage - less scarring. They believe that transumbilical incisions heal imperceptibly. They acknowledge that there’s a steep learning curve with this procedure and that there are potential problems with implant malposition. There’s no question that excellent results can be obtained with this procedure.

The majority of plastic surgeons prefer the transaxillary infra-mammary or peri areolar incisions. They feel that these incisions are associated with a decreased incidence of implant malposition. They also feel that scarring with these incisions is rarely a problem.

They feel that the probability of implant malposition with transumbilical incisions is higher than the probability of adverse scarring with traditional breast augmentation incisions.

It’s important to realize that surgeons have different comfort levels with different incisions. They do their best work when they are able to use their preferred incision. Although good results can be obtained with transumbilical incisions there’s probably a good reason why the majority of plastic surgeons prefer traditional surgical approaches.

Brachioplasty and Scarring

2015-04-07T11:17:00.000-07:00

It’s not unusual for massive weight loss patients to develop redundant upper arm tissue. When this occurs it can represent a significant aesthetic deformity that can adversely impact self-esteem and self- image. When sag of this magnitude is present, the majority of patients require a full brachioplasty.

This procedure involves making an incision that extends from the axilla to the elbow. This approach removes excess skin in the vertical and transverse dimensions. Unfortunately, it’s virtually impossible to hide scars in this location. For this reason, brachioplasty patients are often dependent upon their wound healing characteristics for a good result. In other words, when wounds heal nicely, scars can be imperceptible; conversely, some patients will have notable scars

The vast majority of patients tend to heal these incisions nicely, and the aesthetic results are excellent. Unfortunately, some patients form exuberant scar tissue, which can be very noticeable. When this situation occurs, these scars represent a significant aesthetic deformity which is difficult to hide. Under these circumstances, scar revision and long sleeve shirts may be the only options available for patients.

In the post-operative period, various maneuvers can minimize scarring. These include massage, topical creams, and silastic. If you’re considering this procedure it’s important to understand the potential for scarring and its irreversible nature. The majority of patients have excellent results, but occasionally patients are unhappy with scarring and request scar revision.

Pain Management Following Mommy Makeover Surgery

2015-04-01T07:33:00.001-07:00

The mommy makeover is one of the largest procedures performed in cosmetic surgery. This procedure has several components. These include breast augmentation, breast lift, abdominoplasty, and liposuction of the hips and thighs. The exact procedure performed in any particular case is dependent upon the specific needs of the individual patient.

Pain tolerance varies from patient to patient and is dependent upon a variety of factors. The vast majority of patients who have mommy makeover surgery describe their pain

as moderate. This pain is especially noticeable in the first 24 hours following surgery, but improves rapidly over the next week.

Patients are given narcotic pain relievers in the immediate postoperative period and switched to Tylenol 5 to 7 days postoperatively. It’s not unusual for patients to have pain, which is related to muscle spasm following this procedure. When this situation arises, muscle relaxants are extremely helpful as well.

If you’re concerned about postoperative pain management, it’s important to discuss this issue with your plastic surgeon. Your surgeon should be able to develop a plan that addresses your concerns.

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2015-03-31T08:27:00.000-07:00

Sleeping After a Breast Augmentation Procedure

2015-03-24T14:36:00.002-07:00

Following breast augmentation, there’s always the potential for breast implants to shift and every effort should be made to avoid this problem. In the post-operative period, we recommend that patients sleep on their back for four to six weeks following surgery.

Sleeping on the abdomen or side in the early post-operative period has the potential to cause shifting of breast implants and should therefore be avoided. Sleeping on the back is difficult for some patients and they often move to their side without knowing it. For these reasons, we recommend that patients sleep in a recliner.

After six weeks, we allow patients to resume all their normal activities without restrictions.

What Is Coolsculpting?

2015-03-17T14:04:00.000-07:00

Coolsculpting represents a significant advance in the treatment of problem fat collections. The technique has been clinically proven and has FDA approval.

The procedure involves placing an applicator over the involved area. Suction is then applied, which draws the soft tissue into the device where it’s held in place. The skin and fat are then cooled in a controlled manner. Upon completion of treatment, the involved area is gently massaged to smooth contour irregularities that have been created by the device.

When single anatomic areas are treated, the procedure typically lasts about an hour. Depending on the magnitude of the problem, multiple treatments may be necessary.

Commonly treated areas include the abdomen, flanks, hips, bra strap area, inner thighs, outer thighs, saddle bags and banana rolls.

In the vast majority of patients who undergo coolsculpting the results are excellent. The procedure is very safe and there appears to be no long term problems associated with the procedure.

Unfortunately, the procedure isn't for everyone. Patients with large amounts of fat or loose skin may need more aggressive procedures. In this group, liposuction or skin resections may be more appropriate. It is important to remember that the best results occur when there’s appropriate patient selection and expectations are realistic.

The Best Way to Prepare for a Mommy Makeover

2015-03-11T07:29:00.000-07:00

The mommy makeover is one of the most extensive procedures performed in cosmetic surgery. For this reason, preparing for surgery in every possible way will not only improve your result, but the quality of the experience as well. It’s important to prepare physically, medically, and mentally for this procedure.

It’s important to be in good physical condition before proceeding with this procedure. Ideally, results are best when patients are within ten percent of their ideal body weight. In some cases, patients are unable to reach this goal. This group still benefits from the procedure. In addition it’s also important to maintain good nutrition, exercise regularly and maintain a healthy life style.

It’s also important to be medically ready for the mommy makeover. Patients should be extensively evaluated to rule out other medical conditions. Areas of particular concern include cigarette smoking, blood pressure management and the patient’s baseline hemoglobin.

Mental preparation for the mommy makeover is also extremely important and helps lower the anxiety levels before surgery. It’s important that you have a comfort level with your anesthesiologist, surgeon and the surgical facility. It’s essential that all your questions be answered so there are no surprises.

Arrangements for post-operative care also need to be in order. It’s important to have a care giver not only for yourself, but your children as well. Addressing as many of these issues as possible before surgery will significantly improve results and the quality of the experience.

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2015-03-09T14:43:00.001-07:00

General Anesthesia vs. I.V. Sedation for Breast Augmentation?

2015-03-04T09:01:00.000-08:00

It’s possible to perform breast augmentation utilizing either I.V. sedation or general anesthesia. Each approach has advantages and disadvantages and both approaches have advocates.

It’s important that the anesthesia be administered by a board certified anesthesiologist,

regardless of the type of anesthesia utilized. This is an important point, because I.V. sedation is occasionally administered without an anesthesiologist as a cost cutting maneuver. When this happens, your surgeon is also your anesthesiologist.

I generally prefer general anesthesia for a variety of reasons. I typically place implants beneath the muscle and feel that general anesthesia makes the experience more comfortable for my patients. With newer anesthetic agents, patients tend to recover quickly with less nausea and fewer side effects.

It’s important to discuss these issues with your plastic surgeon before proceeding with surgery. It’s important that both of you are comfortable with the choice of anesthesia. In some cases, it might also be helpful to meet with the anesthesiologist before proceeding.

Cosmetic Surgery and Nicotine Replacement Therapy

2015-03-02T14:35:00.000-08:00

Nicotine causes vasoconstriction of blood vessels which results in decreased blood flow to the skin. Any procedure that requires the elevation of skin flaps can be adversely impacted by this phenomenon. For this reason we generally recommend that patients not use nicotine products for four to six weeks prior to surgery. This includes cigarettes, nicorette gum, patches or anything else that contains nicotine.

It’s important to understand that every patient’s situation is unique. For this reason, this approach may require modification from time to time based on the patients particular needs. Under these circumstances it’s always important to consider the patients risk benefit ratio.

Simultaneous C-Sections and Tummy Tucks

2015-02-24T14:02:00.000-08:00

Abdominoplasty isn't recommended immediately following a C-section for a variety of reasons. These include the inability to make aesthetic judgments immediately following pregnancy, the mother’s overall health status, and the demands of a newborn child on the mother.

The timing of surgery following pregnancy is important and several issues should be considered before proceeding with surgery. It takes time for a new post-pregnancy body to reach its new baseline following pregnancy, and during this transition, it’s impossible to make aesthetic judgments. During this period, stretched skin may contract, a swollen uterus may shrink, and the weight gained during pregnancy may gradually disappear. This process takes 3 to 6 months and needs to occur before abdominoplasty is performed.

Ideally, patients should be within 10% of their ideal body weight and in good health otherwise. The majority of women who have undergone C-sections aren’t in good physical shape and are therefore not optimal candidates for surgery for a variety of reasons. These may include severe fatigue, a depressed immune system, possible blood loss, an increased potential for infection and elevated estrogen levels which can increase the risk of blood clots.

Finally, the demands of a newborn would make the recovery from these combined procedures very difficult. For instance, the use of postoperative pain medications would prevent you from breast feeding. In other words, the abdominoplasty might impact your developing relationships with your newborn child.

For all these reasons, it’s obvious that C-section and abdominoplasty shouldn't be performed together. If you’re considering abdominoplasty it’s important to give yourself time to fully recover from your C-section. Once this has occurred it’s appropriate to consult a board-certified plastic surgeon.

Chest Wall Tightness after Breast Augmentation

2015-02-17T13:33:00.000-08:00

It’s not unusual for patients to complain of tightness of the chest following breast augmentation surgery. This tightness is related to spasm of the chest wall muscles and swelling of the adjacent soft tissue. It’s more common when implants are placed beneath the muscles, but can occur with sub glandular placement as well.

In an effort to minimize these symptoms, a variety of strategies have been utilized. Swelling is managed with compression devices and support bras. Although swelling can be significant in the early post-operative period, it tends to resolve rapidly.

Chest wall tightness can also result from spasm of the chest wall muscles. When this occurs, muscle relaxants and massage are helpful. Massage of the back helps relax the anterior chest wall muscles. These muscles are connected by layers of fibrous tissue and for this reason; massage of the back can help alleviate spasm in the frontal muscles which cover the breast implants.

With time, these symptoms improve and patients are ultimately happy. If you have tightness following breast augmentation, make sure you discuss the issue with your plastic surgeon.

Scar Treatment following Cosmetic Surgery

2015-02-03T14:23:00.000-08:00

A large variety of agents are currently available for the treatment of scarring. At this point in time, there doesn't seem to be a consensus amongst plastic surgeons regarding their effectiveness. Nevertheless, their use appears to be increasing amongst cosmetic surgery patients.

These agents include a variety of topical agents and silastic sheeting. We generally recommend starting them 2 to 3 weeks following surgery as long as no open areas or scabbing is present.

It’ s important to discuss scar treatment with your plastic surgeon. Your surgeon should be able to make an appropriate recommendation.

The Ideal Weight for Mommy Makeover Surgery

2015-01-27T13:36:00.000-08:00

There’s no question that being close to your ideal body weight improves the results from mommy makeover surgery. It also decreases the potential for complications with this type of procedure. For these reasons, we prefer that patients be within 10% of their ideal body weight at the time of surgery.

Unfortunately, reaching an ideal body weight is easier said than done. The vast majority of patients are unsuccessful at losing this additional weight. It’s also important to realize that even when patients are overweight, they can potentially benefit from mommy makeover surgery. We therefore evaluate every patient on an individual basis. We encourage patients to lose weight before surgery and prefer that their weight be stable for at least three months. We realize that some patients will have difficulty losing weight. We therefore encourage patients to be in a supervised weight loss program. Even with that help, some patients will be unsuccessful in their effort to lose weight. Even without weight loss, many of these patients will still potentially benefit from mommy makeover surgery.

It’s important to realize that weight loss following mommy makeover surgery can affect the final result. This could even result in the need for revisional surgery. For these reasons, it’s important to thoroughly discuss this issue with your plastic surgeon.

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2015-01-21T07:38:00.002-08:00

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When to start basic cardio exercises after breast augmentation

2015-01-20T09:59:00.002-08:00

Recovery varies from patient to patient following breast augmentation surgery. We generally recommend that patients avoid strenuous activities including running for at least six weeks following surgery.

Running in the immediate post-operative period has the potential to cause the breast to bottom out. The constant bouncing of the implants within a freshly formed breast pocket can cause the pocket to expand inferiorly. Capsule formation acts to stabilize the implant pocket, but may take weeks to occur. In some cases, two weeks may be adequate, while longer periods may be necessary in other cases.

Physics suggest that larger implants would be more likely to stretch the pocket and skin, while compressive support bras would minimize the phenomena.

Early resumption of strenuous activities such as weight lifting may be associated with post-operative bleeding and hematoma formation as well. For this reason, these activities should also be avoided.

In some cases, low impact cardio exercise such as elliptical, spinning and stair stepping exercises may be resumed as early as two weeks following surgery.

It’s very hard for women who exercise regularly to give up their work out routines. For these patients, it almost represents an addiction. If you’re considering an early return to strenuous exercise, it’s important that you discuss the issue with your plastic surgeon before proceeding. Your surgeon will have important information regarding your situation and when it’s safe to resume all activities.

Arm Lift Scar Position

2015-01-14T10:55:00.000-08:00

When women undergo brachioplasty surgery an incision is made from the elbow to the axilla. Through this incision, excess skin and fat can be removed in both the transverse and vertical dimensions of the upper arm. The exact placement of this incision is dependent upon several

variables.

In the majority of cases, the incision is placed on the inner arm between the biceps and triceps muscles. In this position the scars are well hidden when the arms are at the patient’s side. When patients raise their arms, the scars become more noticeable.

Occasionally, women prefer scars that are more posteriorly located. In this position, scars don’t tend to spread as much because the skin is thicker in this location.

It’s important to understand that scarring is inevitable with this procedure, irregardless of the incision placement. The most important variable in scar formation is the patients wound healing biology. This varies from patient to patient and for this reason incision placement needs to be individualized.

If you’re considering brachioplasty, it’s important to discuss these issues with a board certified plastic surgeon before proceeding. This surgeon should be able to formulate a treatment plan that addresses this issue.

Coolsculpting Complications

2015-01-06T13:45:00.001-08:00

Coolsculpting has been available in the United States for several years and in Europe for a much longer period of time. Over 50,000 patients have undergone Coolsculpting safely with minimal complications.

The procedure involves placing an applicator head over the involved area. Suction is then applied, which draws the soft tissue into the device where it’s held in place. The skin and fat are then cooled in a controlled manner. Upon completion of treatment, the involved area is gently massaged to smooth contour irregularities that have been created by the device.

Patients typically describe an uncomfortable feeling as if a block of ice was being held against the area. Within ten minutes, the area becomes numb and patients become more comfortable. At this point they are able to read a book, watch a DVD, listen to music or sleep.

A small number of patients experience bruising and swelling which spontaneously resolves in 2-3 days. Occasionally, patients experience pain which is often described as dull and achy. This also resolves quickly.

Rarely, nausea can occur when abdominal Coolsculpting is performed and is probably secondary to traction on the abdominal contents. This is fortunately uncommon and quickly resolves on its own.

These problems occur sporadically and don’t appear to be modulated by mechanical factors such as applicator size. At this time, no long term complications have been identified with this procedure. The procedure is associated with high satisfaction rates and is an excellent option for treating localized adiposity.

Pre-Operative Blood Testing

2014-12-30T09:11:00.001-08:00

The vast majority of patients who are undergoing cosmetic surgery have preoperative blood testing which includes a CBC. This test has several components which are critical elements of the preoperative evaluation. These include the platelet count, the white blood cell count, and the hematocrit and hemoglobin levels. Each of these measurements is extremely important. The platelet count measures the patient’s ability to clot blood, an elevated white blood cell count is an indicator of infection, while the red blood cell count, hematocrit, and hemoglobin all measure the body’s oxygen carrying capacity.

Occasionally other blood tests are performed in combination with a CBC based on your physical findings.

If you’re concerned about your preoperative blood testing, it’s appropriate to consult your plastic surgeon. Your surgeon should be able to discuss these lab values in detail.

Pregnancy Following Tummy Tuck Surgery

2014-12-23T09:30:00.002-08:00

The vast majority of women who undergo tummy tuck surgery are done having children. Rarely, women who have undergone abdominoplasty change their minds about additional pregnancies or accidentally become pregnant. Under these circumstances, tummy tuck has no negative impact upon the pregnancy. Unfortunately, pregnancy has a negative impact upon the patient’s previous abdminoplasty. Pregnancy recreates many of the patient’s original problems, including loose saggy skin, weakened abdominal muscles, and stretch marks.

Because of the significant investment in time, money, and effort, we strongly recommend that patients be done having children before proceeding with abdominoplasty. Even when women don’t plan on having additional children, their life circumstances change and they become pregnant. Under these circumstances, revision of the original tummy tuck can be undertaken with success.

How to Get Rid of Flabby Arms

2014-12-16T09:00:00.000-08:00

Flabby upper arm tissue can represent a significant aesthetic deformity that can adversely impact self-esteem and self-image. When this situation arises, several treatment options exist which can improve upper arm aesthetics. These include liposuction, mini brachioplasty and full brachioplasty. The procedure chosen is dependent upon the patient’s aesthetic goals and specific anatomic findings.

In some cases, liposuction may be a viable alternative. When this procedure is utilized, scarring is minimal and results are usually excellent. Unfortunately, this procedure is only effective when fat is present and skin is relatively tight.

When excess skin is confined to the upper arm in the area of the axilla, a mini brachioplasty may be effective. This procedure utilizes an incision in the upper arm which is transversely oriented and well hidden. The procedure is helpful when patients have minimal excess upper arm skin and is associated with excellent results.

Unfortunately, the vast majority of patients who have had significant weight loss require more extensive procedures. In most cases, this involves a full brachioplasty with an incision that extends from elbow to axilla. This procedure addresses excess skin in the vertical and transverse dimensions. In most cases, results are excellent, but occasionally adverse scarring can be a problem.

When significant excess skin is present laser tightening and other non- surgical treatments aren’t effective. For this reason, patients who have significant arm skin sag should consult a board certified plastic surgeon who can formulate an appropriate treatment plan.

Will Skin Be Tightened After Liposuction?

2014-12-09T09:38:00.002-08:00

Skin tightening following liposuction varies from patient to patient and depends on a variety of factors. It’s not unusual to have skin tightening following liposuction in patients who are younger and have good skin tone. In older patients with poor skin tone, liposuction might result in skin sag because of poor skin contraction.

Skin tightening isn't unique to post-operative liposuction patients, but also occurs following massive weight loss and pregnancy. How individual patients respond to these changes is dependent upon their genetics and biologic behavior. Although multiple liposuction techniques are available that reportedly tighten skin, the patients wound healing biology and genetics are the most important variables.

If you’re considering liposuction and are concerned about skin sag, it’s important to consult a board certified plastic surgeon with experience in this area. This surgeon should be able to assess your risk for skin sag.

Weight Loss Before Liposuction

2014-11-25T08:55:00.000-08:00

Whenever possible, patients should be near their ideal body weight before they undergo liposuction. For some patients this just isn’t possible and under these circumstances a stable body weight is acceptable. When patients are actively losing weight, it’s appropriate to delay surgery until a stable weight has been obtained.

It’s important to realize that weight fluctuations after surgery can adversely impact the results of liposuction. For this reason, every effort should be made to reach a stable weight that can be easily maintained before and after surgery.

Massage After Liposuction

2014-11-18T11:23:00.004-08:00

There are no scientific studies that conclusively demonstrate that massage is helpful following liposuction. Despite this, many plastic surgeons utilize massage as a routine component of postoperative care following this procedure. They believe that massage minimizes internal scarring, decreases edema, and helps remodel soft tissue.

It’s not unusual for patients to complain of swelling, tightness, and stiffness following this procedure. Massage and an early return to physical activity seems to help with these issues. For these reasons, plastic surgeons often recommend gentle massage and stretching exercises after liposuction. These are usually started 7 to 10 days following the procedure. Initially these maneuvers cause mild discomfort which quickly resolves with time.

If you’re planning liposuction, it’s important to discuss this issue with your plastic surgeon. In many cases, massage will be an important part of your postoperative care.