Category Archives: ARM SURGERY

Mommy makeover-Breast-Abdomen plastic surgery

Mommy makeover

Mommy surgery before

                                                                                    Mommy surgery after

Cosmetic Plastic surgery of breast and abdomen after childbirth or massive weight loss is often called a Mommy makeover. Recently a patient asked me if in fact it was not a ‘Mummy makeover” since patients are often bandaged up like mummies after this cosmetic surgery duo!

 

Changes  to body after pregnancy or weight loss

Several distinct but common changes occur to the body after pregnancy or weight gain and loss.

  • Fat Deposits – occur in the flanks, love handles, back and abdomen
  • Loose skin – as a result of stretching of the skin leads to loss of elasticity of skin and its hanging down
  • Breasts become smaller and may also become droopy due to loss of volume and elasticity- in women and men!
  • Arm skin becomes droopy but fat accumulation in the arms may increase
  • Facial  and neck skin may droop giving an older look

 

Surgery of the abdomen and breasts

Mommy makeovers typically include

Other procedures may include

Mommy makeovers will take between 3.5 to 4.5 hours depending on the type of surgery that needs to be performed. Though some surgeons like to continue to operate on other body areas at the same time, I find that 8 hour cosmetic surgeries are just too much for me. They are also way too much for the patient! I prefer to divide up the surgeries into more reasonable segments, sometimes just by a few days, to allow easier healing for patients.

Recovery from Mommy makeover

After a mommy makeover the recovery will depend on the number and type of procedures performed as well as all the usual reasons for differences in individual healing. Although patients are up and walking the same day as surgery, typically it will take about 10-14 days before patients are back at work. I have had patients return as soon as 3 days after surgery and as long as 14 days.

Here is a link to a patient returning to the office after only 12  hours following mommy surgery;  http://www.youtube.com/watch?v=HCqqri8Yt5M&list=UUGHAP0wTkrkJuRo1yN1CFjg

Full healing though will take about 4 months though their healing is gradual and progressive.

Mommy makeover surgery gives women a new look . A new look for their bodies and a new look on life.

Preventing Infections with Cleanliness, Part 1

What are infections and what can we do about them?

 

Admit it. You’ve been there. Once you are finished, you go to wash your hands. Do you turn on the faucet, which has been touched by the dirty hands of god knows who? What about the paper dispenser? Now, how do you get out of the bathroom? Do you dare pull the handle, which those who did not wash their hands may have touched as they left? Let’s face it—taking a pee in a public bathroom is a stressful experience.

I have previously written on this subject as it relates to a hospital environment and preventing infections: https://tavmd.com/2011/07/30/alcohol-kills-germs/

We live in a pretty dirty world, but a little prevention can help keep you healthy. For example, a recent study showed that the handles of two thirds of grocery carts are contaminated with fecal material. Also, 70% of the lemon wedges in your drink at a restaurant were found to be contaminated with bacteria—E. coli or fecal bacteria! As a cosmetic patient or plastic surgeon, minimizing the risk of infection is important for recovery.

How bacteria cause infection

Our bodies are teaming with bacteria. There are billions of them in different parts of our bodies—even our left and right hands have different types of bacteria on them. Even though we think of the anus as the dirtiest part of the body, there are actually more types of bacteria in our mouth than in any other body part (our mouths are, in that sense, dirtier than a dogs’ mouths, which have less bacterial load and variety!).

Infection as a disease occurs when either:

  1. Pathogens (bacteria or viruses) break through our natural defenses against infection, such as through a break in the skin, or
  2. There is an imbalance in the normal bacterial flora where the different types keep each other in check 

Some particularly virulent bacteria, like some strains of E. coli, streptococcus and salmonella, don’t need much of a break in our natural body defenses to enter and cause infection. A small scratch in the skin, some inflammation of the gut. Others, like Clostridium difficile, lurk in the intestines, and if you are on antibiotics and kill off your normal gut flora, the C. diff. goes wild, takes over and makes you sick.

 

Natural defenses against infection

Once the bacteria is inside our bodies, we have a number of defenses:

  1. Antibodies – small proteins circulating in our blood that attach themselves to and destroy pathogens
  2. White blood cells – a number of different types of white blood cell are present in the blood and will accumulate and kill invading organisms.

 

What antibiotics do

If you go to the doctor, he or she will give you antibiotics, which are medicines that either:

  • directly kill bacteria, or
  • prevent their replication

If you have a viral illness, there is usually not much to do but keep yourself comfortable, hydrated and rested until the disease hopefully runs its course. Only a few viral illnesses, such as herpes and HIV, have medicines available that can slow the rate of replication and keep you somewhat healthy. Some viral illnesses can now be immunized against, such as:

  • HPV (human papiloma virus, which has been linked to cervical cancer)
  •  Herpes zoster (which gives you shingles)
  •  Hepatitis C

 

Cleanliness as a way of fighting the risk of infection

All of this is important because to remain healthy, we need to limit our exposure to bacteria and viruses. One of the best ways to do this is to clean our hands and bodies regularly to decrease the amount of bacteria on our bodies. We don’t want to take a bath in alcohol every day—that would kill almost all the bacteria and leave us open to attack by the one strain or another that was not killed, like the C. diff. example above. We just need to limit our exposure to pathogens.

 

Where are pathogens located?

Pathogens are located everywhere. Most commonly, though, bacteria and other pathogens are associated with dirtiness—dirt on our bodies or dirt on the food we eat and water we drink. Purifying water and properly cooking and washing food takes care of many pathogens. Dirt on our bodies should be washed away with soap and water. Alcohol sanitizers will also kill many pathogens on our hands—use them!

In a recent issue of the Wall Street Journal, there was a small article about some studies that have been done on the subject of public bathrooms and the public’s preferences and habits regarding them. I became re-interested  in the question of handwashing a few weeks ago myself.  I was watching the movie Contagion, in which a worldwide killer disease is passed from one person to another through the air (by sneezing and coughing) or from fomites (transmission from one person directly to another by touch or via rough physical objects like door handles and glasses). You soon realize that we are essentially constantly touching each other. Another interesting fact I learned from the movie: we touch our faces between 2000 and 3000 times a day!  And our noses are where most of the pathogens hide. Also, average adults touch up to 30 objects a minute!

In the next post, I’ll amaze you with some facts about using public restrooms.

Morad Tavallali, M.D., FACS

How to Decrease Bruising after Plastic Surgery

How to reduce bruising after plastic surgery 

 

This post is about how to reduce bruising, but it’s important to read a previous post about how to decrease swelling after plastic surgery before reading on:

https://tavmd.com/2012/11/13/how-to-decrease-swelling-after-cosmetic-plastic-surgery/

Causes of bruising after cosmetic plastic surgery

Let’s see how bruises form. When blood vessels are injured in surgery through cutting, they will bleed into the tissues around them. This bleeding shows up as bruising (in a red, blue and black color) under the skin. Any action or medication that interferes with or delays the normal healing process and stops blood clotting will cause bruising. With time, leaked red blood cells start to break down into bilirubin and iron components, creating a yellow color as the bruises heal. White blood cells then come into the injured skin area and start to remove the remnants of red blood cells.

Some areas of the body are not covered with skin, such as the eyes. When bruising occurs around the eyes, such as after a cosmetic eyelid surgery, blood actually shows red in the white part of the eye!

Here are some other posts about swelling and bruising and the use of ice and heat after plastic surgery:

https://tavmd.com/2011/08/30/swelling-after-liposuction/

https://tavmd.com/2011/02/05/should-i-apply-heat-or-cold-after-plastic-surgery/

 

How to stop bruising after plastic surgery

Stopping bruising involves not only the removal of blood that has seeped into tissues, but also mechanisms to heal vessels and encourage clotting along injured vessel walls so that no more blood seeps out.

  • Elevation of injured area

Decreasing blood flow will decrease swelling and the amount of blood that seeps into the skin through injured vessels.

  • Ice

Cold contracts blood vessels, resulting in fewer cells going out into the tissues. Likewise, avoiding heat (heating pads or warm towels) will be beneficial in the initial 72 hours after surgery because it increases flow and bleeding before the blood vessels have had time to heal.

  • Avoidance of NSAIDs

NSAIDs (see above) decrease blood clotting. Specifically, they decrease the production of prostaglandins, which are essential for forming a clot. No clot and you keep on bleeding. Swelling might be decreased, but you keep on bleeding!

 

  • Foods to increase vitamin K

Food high in vitamin K levels, such as green leafy veggies (or even vitamin K pills), can also help clotting.

 

  • Pressure on injured area

Applying pressure to bleeding areas will help clotting, decrease swelling and decrease the amount of blood that escapes. Once bleeding has stopped, pressure does not do any more good other than to decrease swelling.

 

  • Application of heat after 48 hours

The initial application of ice to an injury site will decrease bruising. After 48 to 72 hours, though, once the blood vessel has clotted, applying gentle heat with something like a moist warm towel will encourage blood flow through normal vessels, which aids in the removal of remnants of dead red blood cells in tissues. Some of my Far Eastern patients roll freshly hard boiled eggs (shell on) over the areas of bruising for heat and massage at the same time!

Of course, you should call your plastic surgeon immediately if you have an area of bruising under the skin that is getting large. This may be a hematoma, a large collection of blood under the skin that may need to be surgically removed.

 

Morad Tavallali, M.D., FACS

Cosmetic surgery doesn’t mix with alcohol

Alcohol and surgery

Last night a patient called me at 11.30 (after my bedtime) to ask me if she could have a beer. She was recovering from a breast enlargement surgery, brazilian buttock lift and mini tummy tuck. The cosmetic plastic surgery procedure was ten days ago.
I was initially a bit pisssed off. After all she had called the emergency line after hours; a line reserved for true medical emergencies. I initially thought of telling her NO! NO beer! but then realised that it might have been an emergency beer she needed and so told her to go ahead and swig one back!

See here for links to some articles on postoperative care https://tavmd.com/category/general/pre-and-post-surgery/

Complications of plastic surgery occur at known rates for infection, bleeding etc. It is important though not to increase your chances of having a complication by limiting factors that delay your healing or give post operative recovery problems. Alcohol causes problems in this period!

 

Alcohol after cosmetic surgery

The timing of when a patient can start to drink alcohol after cosmetic plastic surgery will depend on a number of factors. The basic factor is that alcohol has a number of effects that can alter postoperative results of a cosmetic patient.

 

Alcohol as vasodilator of skin

Vasodilation means opening of blood vessels. You may know those ruddy cheeks you get when you have had a few too many drinks. You know, red cheeks along with a warm feeling, slurred speech and bad jokes?  Skin vessels will open to allow more blood into them and rob blood volume from vital organs. You are already dehydrated from surgery and with more loss of fluid from areas that need it- brain and heart- you will only feel light headed, get nausea and worse!

 

Alcohol as a nervous system depressant

Alcohol effects our brains by depressing our central nervous system.

Initially this means decreasing our psychological inhibitions and mellow us out. It also mellows out our breathing rate and brings it down . If you are taking narcotics for pain control, they also decrease your breathing rate. The additive effect can mean you stop breathing! Not good for a cosmetic surgery recovery.

Alcohol increases vomiting

Another effect of alcohol is to increase our brain’s sensitivity to noxious stimuli and make it easier for us to vomit. Not good if you have had any type of cosmetic surgery. The anesthesia will already have lowered your vomiting threshold. With a tummy tuck vomiting will be very painful as stomach muscles contract. With a face lift,  increase in blood pressure occurring with vomiting can lead to bleeding.

 

Alcohol as a diuretic

Alcohol also has the effect of increasing the rate of urine formation (increases your peeing) and as such can lead to dehydration. That is why when you have a hangover you have a headache. Dehydration causes fluid to leave the area around your brain (cerebrospinal fluid)  which leads to headache. If you are already dehydrated from surgery, the increase in dehydration will only make you feel worse.
You may think that alcohol will allow you to relax after your cosmetic plastic surgery and maybe it will if taken in moderation. However you will be better off taking a Valium to decrease your anxiety and avoid all the other alcohol side effects.Also drink lots of…water!

Liposuction of the Arms

Liposuction of the Arms

Some people are born with fat arms, some get them with time and almost everyone ends up with some arm laxity and a little wobble sooner or later. The distribution of fat in the arms is, like all other fat distribution, determined by genetics. We are programmed from birth to store fat at different times in our lives and in different areas. Typically, the primary storage areas are the thighs and the abdomen. Fat storage in the arms is usually a secondary storage area but one that has much more cosmetic visibility than other areas. Requests from patients for cosmetic plastic surgeons to reduce the fat are quite common.

Where is the fat in the arms?

Arm fat is distributed around the whole circumference of the arms but usually is more pronounced in the triceps area (the back of the arms). The area over the deltoids (back of the shoulder) also seems able to hold a good amount of fat. In contrast, even though there may be a little fat below the elbow, that is not an area I have ever liposuctioned.

How is the fat removed?

Liposuction is the best method to remove fat from the arms. I usually perform the lipo in the office under local anesthesia. One 5 mm incision is made at the elbow and another in the armpit to allow placement of local tumescent anesthesia. Liposuction is then performed using small cannulae of 2mm and 3mm diameter, taking out fat in little “cylinders.” The skin becomes loose by the end of the surgery as fat is removed.
After surgery, arms are wrapped for a day or two, and I tell my cosmetic patients to sleep with their hands elevated to reduce swelling. All bracelets and rings must be taken off  prior to surgery and not put back on for several days until the swelling is gone.

Healing after liposuction

I allow my patients to remove their dressings and place themselves in a T-shirt with long sleeves. The idea is to have just a little support to lower the discomfort from swelling. Exercise can be started in two weeks, and patients are encouraged to stretch the arms and massage them regularly until they feel fine again—sometimes after about 2-3 months after the surgery! Liposuction provides a relatively quick, efficient and effective treatment for fat arms. Patients can once again enjoy wearing short-sleeved shirts and dresses and not have to worry about hiding their arms.

After Weight Loss Comes the Surgery; Arm Lifts

After Weight Loss Comes the Surgery; Arm Lifts

 

Patients who have undergone gastric bypass or gastric stapling, or who have managed to lose weight by other means (diet?), are often left with a body contour that needs significant amounts of surgery for correction. The weight gain will have stretched the skin and caused loss of elasticity. After the weight loss, the skin just hangs; it hangs in the belly area, usually needing a tummy tuck to correct; it hangs in the breasts, needing a breast lift with or without a breast augmentation with breast implants; it hangs in the thighs, where you need a thigh lift; and it hangs in the arms, where you need an arm lift to correct the resultant deformity.

Old arm lift surgery

Traditional arm lifts have included a vertical scar that goes from the elbow directly to the armpit. This unsightly scar makes the arm smaller and removes the “bat wings” of extra skin hanging down, but the cost is, in my opinion, too great. All too often, plastic surgeons perform cosmetic surgery without really thinking about what the patient wants. In the case of arm lifts, the cosmetic patient wants a plastic surgery that will allow him or her to wear a short-sleeved shirt. They do not necessarily want smaller arms; OK, they do, but only to be able to wear the shirt they want. As such, an arm lift surgery that leaves a long scar behind the arm will lead to the patient NOT baring their arms—the whole point of the surgery is lost. It’s the same for vertical scars in a tummy tuck or in a thigh lift: skin is removed in these cosmetic procedures, but the plastic surgeon is not really doing the patient a favor.

My arm lift surgery

The technique I use for an arm lift is a liposuction of the arm to remove any extra fat that is remaining after the weight loss followed by a skin excision in the armpit. The horizontal scar under the arm is well hidden and allows the patient to bare their arms. Look at the junction of your shirt’s body and sleeve; the scar goes in the same position on your body. It is true that maybe a little less skin can be removed in this technique, but the result is well worth it. I sometimes combine a lipo of the skin of the sides and pull that skin up also. The surgery takes about two hours and is performed on an outpatient basis. The patient has to be a little careful in lifting their arms for a few days, but they are up and at it in a couple of days. Full healing can take a month or so. This is the way an arm lift should be done. The vertical scar technique should be banned.

 

Morad Tavallali, M.D., FACS

Cosmetic Plastic Surgeon


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