Body Procedures
Liposuction
Procedure Overview:
Liposuction (Suction-Assisted Lipectomy) – Liposuction consists of the removal of excess fatty tissue all over the body and even the face. It is one of the most commonly performed plastic surgery procedures. In expert hands, the procedure is safe, reliable and very rewarding. Traditional liposuction removes fat with a suction machine and a small cannula that is moved beneath the skin. A number of techniques can be used at the surgeon’s discretion. Ultrasound-assisted lipoplasty (UAL) is a technique in which an ultrasound probe is inserted beneath the skin to “liquefy” the fat before it is suctioned. Power assisted liposuction (PAL) is a technique in which the cannula is put in motion with a machine. There are laser based machines that liquefy fat which is subsequently removed with the standard cannula. Ultimately, it is the surgeon who determines the safety and quality of your results and not the machine.
The tumescent technique refers to the infusion of a saline solution containing a local anesthetic into the fat before liposuction to reduce blood loss and post-operative bruising and swelling. Larger volumes of fat removal require special expertise and appropriate staff and facilities. Please review my article The Art of Liposuction for a more thorough discussion of this popular procedure.
Anesthesia Options:
General recommended, or in some cases Local with IV sedation. Small cases of isolated fatty deposits can be performed with tumescent anesthesia alone.
Risks and Benefits:
Temporary bruising, swelling, numbness, soreness, burning sensation, temporary fluid drainage from incision sites, asymmetry, rippling or bagginess of skin, and pigmentation changes. Large volume liposuction is associated with greater risks including shock and even death. The benefits of liposuction range from treatment of relatively small “difficult” areas to complete body reshaping. In appropriately selected patients, liposuction can be a catalyst to beneficial life changes. Liposuction is not performed for weight loss.
Recovery:
Recovery varies greatly depending on the amount of liposuction done. Most people can return to work after several days and be back to exercising in 2 weeks. Full recovery from swelling and bruising can take several months. The use of postoperative homeopathic supplements such as Arnica and Bromelain may decrease post-operative bruising and swelling. Endermology treatments are recommended in most cases to ensure optimal skin retraction. When larger amounts of fat is removed it’s not uncommon to feel less energetic for several weeks. It’s important to move about after liposuction to speed recovery. Compression garments are worn for about four weeks. Areas of skin numbness recovers after a few months.
Dr. C’s Take:
A wonderful procedure in expert hands for sure. Very disappointing if not dangerous in the hands of those who have no business offering this service. Buyer beware big time here–do not succumb to marketing gimmicks and inflated promises. This is a real procedure that should not be trivialized. It’s the smoothness and evenness of results that is most important to a satisfying experience. The surgeon is the artist, not the device used to contour the fat. Treating irregularities and asymmetries from a “botched” job is almost impossible.
Tummy Tuck (Abdominoplasty)
Procedure Overview:
Tummy Tuck (Abdominoplasty) – Abdominoplasty is a major surgical procedure to remove excess skin and fat from the middle and lower abdomen and to tighten the muscles of the abdominal wall. The procedure can dramatically reduce the appearance of a protruding abdomen. If your fat deposits are limited to the area below the navel, you may require a less complex procedure called a partial abdominoplasty; also know as a mini-tummy tuck.
Anesthesia Options:
General anesthesia or local anesthesia combined with IV sedation for a mini tuck at the discretion of our anesthesiologist.
Side effects/risks:
Temporary pain, swelling, soreness, numbness of abdominal skin, bruising, and fatigue for several weeks. Blood clots, infection, bleeding under the skin flap, poor healing resulting in conspicuous scarring or skin loss, and the need for a second operation are much less common complications.
Recovery:
For the first few days, your abdomen will be swollen and you will experience pain and discomfort that can be controlled by oral medication. We also infiltrate numbing medication in the abdominal fascia that helps reduce discomfort considerably. All patients are sent home the day of their procedure. Though you may not be able to stand straight at first, you should start walking as soon as possible and as the tightness softens over the week you will walk normally. In healthy motivated patients, recovery usually lasts two weeks at most. Many patients return to work after one week and resume exercise in three or four weeks depending on their tolerance. It’s important to remain slightly flexed at your waist in order to be most comfortable and reduce the tension on your repair. Mild swelling can persist on the lower abdomen for 6 to 8 weeks. Drains are usually inserted at your procedure and will remain for about 5 days.
Heavy lifting is avoided for the first two weeks (25 pounds or more). Extra help will be beneficial for the first seven to ten days particularly if there are young children around (Having your mom around or other family is really special). Sleeping in the flexed position for the first week or so will provide extra comfort. A recliner or hospital bed (rented) has come in quite handy for many patients.
Your scars may actually appear to worsen during the first three to six months as they heal, but this is normal. Expect it to take nine months to a year before your scars flatten out and lighten in color. It is recommended that you use silicone scar strips on your incisions for at least six months afterwards in order to ensure the finest scar. This must be worn for at least 12 hours a day. We encourage patients to wear store bought compression garments for several months after the procedure for swelling control, general comfort and scar softening.
*Please note that abdominoplasty scars always look worse in photographs than in real life. Also, most post operative photos are taken at four months when scars have not yet fully matured. Complaints about an abdominoplasty scar are uncommon.
Male Breast Reduction (Gynecomastia)
Procedure Overview:
Male Breast Reduction (Gynecomastia) – This procedure reduces enlarged breasts in men using liposuction and/or surgical removal of excess glandular tissue. Most incisions are around the areola. Advanced cases may require removal of skin excess with a longer scar across the chest. Excessive fat and glandular tissue would best be treated with liposuction and tissue removal. There are medical conditions that cause breast enlargement (tumors, marijuana use, medications).
Anesthesia Options:
Local anesthesia to general anesthesia depending on the complexity and your level of tolerance.
Risks and Benefits:
Moderate pain, bruising, and swelling are to be expected. Hematoma (blood collection) is probably the most common complication. Uneven skin retraction can lead to skin irregularities. Additional procedures may be needed for irregularities. The benefits are GIGANTIC in most cases as men don’t want breasts. The psychological damage from this condition should not be underestimated. The improvement in body self image (and the ability to wear a T shirt) is wonderful.
Recovery:
You will feel some discomfort for a few days after surgery. However, discomfort can be controlled with medications prescribed by your surgeon. It will take about seven weeks for most of the swelling to go away. You will see an immediate improvement, but time is needed for all the swelling to dissipate. Compression garments are essential. Deep massage of healing tissue is very beneficial.
Dr. C’s Take:
A “must have” procedure for those who have been traumatized by the presence of fullness in the chest. The contouring by your surgeon must be done to perfection so that there are no contour irregularities. It has been my experience that ANY tissue left for any reason is generally not a good thing (patients want it gone–all gone). Read my article Gynecomastia to become an expert.
Arm Lift Surgery (Brachioplasty)
Procedure Overview:
Arm Lift Surgery (Brachioplasty) – A brachioplasty is a surgical procedure involving the skin and fat of your arms, typically the posterior part. Some people are born with large arms while others develop loose, hanging skin with increasing age or after significant weight loss. In some cases liposuction alone can improve the size and shape of the arms. In others, removal of tissue with a scar is needed for the best improvement. The scar typically runs from the armpit to the elbow. If placed well, this scar is not visible when your arms are at your side. In patients who have loose skin that is located near the under arm area alone, it’s possible to remove skin so that the scar is hidden in the armpit.
Anesthesia Options:
General Anesthesia, or in some cases IV Sedation or even local.
Risks and Benefits:
The most common problem associated with this surgery is wound healing and final scar appearance. Scars are the greatest drawback to this operation. Smokers are advised to discontinue smoking three weeks prior to surgery, as smoking increases the risks of complications and delays wound healing by altering blood circulation in the skin.
Complete scar maturation takes about a year and a half. This is when your scar will begin to look its best. Scars will be red and raised at first but typically flatten and lighten over time. The benefits of the procedure is a slender arm that does not “jiggle.” Patients are not so self-conscious about their arms. Patients feel more comfortable wearing clothing that shows their arms.
Recovery:
Your arms will be swollen for several weeks following the procedure. Your hands may swell. Arm elevation is important to prevent excessive swelling. I will see you at the office 2-3 days following surgery to remove dressings, assess your wounds and to possibly remove drains if used. Silicone gel sheeting is recommended to ensure the best scar possible. I recommend the use of compression garments for up to six weeks after the procedure to control swelling and improve post operative skin contour.
Dr. C’s Take:
This is a good procedure in the right patient. The scars are significant and a large percentage of them will spread when then heal. Again, expert surgery is needed to “get it right” and make sure the scar is in the most inconspicuous position. Don’t underestimate the value of liposuction alone in this area as the ability of the skin to retract is quite impressive.
Thigh Lift (Thighplasty)
Procedure Overview:
Thigh Lift (thighplasty) – A thigh lift is a procedure to remove excess skin and fat from the inner or outer thighs. It is a common consideration in patients who have lost significant weight. It only contours the skin in the uppermost region of the medial legs and will not improve the area down the leg near the knees.
Anesthesia Options:
General or local with sedation.
Risks and benefits:
The risks of the procedure typically involve wound healing issues like wound drainage and delayed healing. There is the distinct possibility of a wound infection because of the location of the incision in a warm, moist area. The benefits are a significant reduction in the fullness in the upper part of your legs, less rubbing of the skin and less skin excess. The contour of your leg is improved.
Recovery:
There will be some pain and tightness associated with this procedure in your upper things. Swelling will last for several weeks. The incision takes a few weeks to heal completely. Compression garments are recommended for several weeks. The incision needs to be kept clean and dry to minimize the potential for would healing problems. Any leg movements that place tension on the wound will be associated with pain and should be minimized. I recommend that you have four or five days to relax after the procedure. Exercise can start about three weeks after surgery. It takes about a year and a half for the scar to look its best.
Dr. C’s Take:
This is a really nice procedure in a carefully selected patient. Unfortunately, most patients expectations exceed what can be delivered by the procedure. Patients “want it gone” but the procedure only makes it better. When I see patients in the office they put their hands on the mid part of their thighs and pull upwards. This makes the skin look really nice and youthful. This is not what you get from a thigh lift. If this were the case, I would be doing this procedure all day. I rarely see patients really thrilled about the results from a thigh lift even though there is a significant improvement. Combining this with an abdominoplasty may not be the best idea as the two different procedures pull in two opposing directions potentially adding to post operative complications and wound healing problems.
Buttock Enhancement
Procedure Overview:
Most women prefer a round buttock area rather than a flat one. Some women are born with a flatter buttock, while others have buttocks that have “fallen” with advancing age or pregnancy. Universally, women prefer a firmer, tighter buttock.
What are the options when it comes to buttock enhancement, and what plastic surgery procedure, if any, actually works?
These are the current options for buttock enhancement:
- Liposuction. This option works very well when you are starting out with a large buttock area and you are seeking something smaller and better shaped. Liposuction is performed around the buttock and hips, essentially “liposculpting” a smaller buttock from a larger one.
- Buttock implant. This option has been referred to as the “Brazilian” butt lift. A silicone implant is placed in the buttock for added fullness and roundness.
- Fat injection. Fat is borrowed from one area of your body and transferred to the buttock using small cannulas or tubes.
- Buttock lift by skin removal. The buttock can be “lifted” by excising skin above it, helping to reduce loose or saggy skin. Weight loss patients are often candidates for this procedure.
- Exercise. Working out is another way to achieve a tighter, rounder buttock area. This helps, but it requires effort. It’s reasonable to assume that those most likely to complain about a loose buttock area are those least likely to spend time in the gym.
Anesthesia Options:
General Anesthesia is recommended in most cases.
Risks and Benefits:
Liposuction of a large buttock to sculpt a smaller one is the safest, most reliable procedure. Buttock implants are associated with at least a 25% complication rate. Fat grafting sounds good, but is quite unpredictable. Buttock reshaping by skin removal works well in weight loss patients. Exercise is a no brainer. The benefit of all these procedures is a nicer “posterior!”
Recovery:
Liposuction would be the shortest, most comfortable recovery measured in terms of five days or so. An implant is more painful and may take two weeks before you can sit comfortably. Fat injection recovery is the longest because you will need to avoid any pressure on your bottom to “help” with the fat “take” (this may mean three weeks of no pressure). Skin excision techniques take about two weeks or so to recover. And of course, there is no recovery with exercise!
Dr. C’s Take:
This is where it pays to have a large buttock area that I can make smaller. I would only recommend a buttock implant in those patients who are fully informed of the risks and accept them. I have never been happy with the fat take from fat transfer techniques. Body “lifting” techniques with skin removal is a good alternative in select patients. Exercise has benefits all around; it shapes and tones, and it makes you feel that it’s better.
Scar Revision
Procedure Overview:
Scar Revision on the Body – While no scar can be removed completely, plastic surgeons can often improve the appearance of a scar, making it less obvious through the injection or application of certain steroid medications or through surgical procedures known as scar revisions. Z-plasty is a surgical technique used to reposition a scar so that it more closely conforms to the natural lines and creases of the skin, where it will be less noticeable. It can also relieve the tension caused by contracture. Not all scars lend themselves to Z-plasty, however, and it requires an experienced plastic surgeon to make such judgments. Skin grafts and flaps are more complex forms of scar surgery. Your surgeon decides the need for these.
Anesthesia Options:
Skin grafts and flaps: general anesthesia.
Duration of Results:
Permanent.
Side effects/risks:
These procedures are normally safe, but there is always the possibility of complications. These may include infection, bleeding, a reaction to the anesthesia, or the recurrence of an unsightly scar.
Recovery:
Skin grafts and flaps require several weeks or months for complete healing.
Skin Cancer
Procedure Overview:
Skin Cancer on the Body – While skin cancers can be found on any part of the body, about 80 percent appear on the face, head, or neck, where they can be disfiguring as well as dangerous. Most skin cancers are removed surgically, by a plastic surgeon or a dermatologist. If the cancer is small, the procedure can be done quickly and easily. The procedure may be a simple excision, which usually leaves a thin, barely visible scar, or curettage (scraping) and electrocautery may be performed. In this procedure the cancer is scraped out, and an electric current is used to control bleeding and kill any remaining cancer cells. This leaves a reddened area for some time, which eventually turns white or skin colored.
Anesthesia Options:
Local.
Duration of Results:
Variable – recurrences are possible.
Side effects/risks:
Depending on the location and severity of the cancer, the consequences may range from a small but unsightly scar to permanent changes in facial structures such as your nose, ear, or lip.
Recovery:
Varies depending on the complexity of the procedure performed.
