Category Archives: LIPOSUCTION SURGERY

Buttocks plastic surgery update

Buttocks plastic surgery update

 

buttock shapes

I recently saw a classification for buttock shapes. It turns out there are pear, apple, mandarin and tomato buttock shapes.  Funny but no one told me that during my training. It also appears that the citrus fruit among these, mandarin, is the shape most aspire to: two round balls for buttocks. Buttocks plastic surgery keeps on evolving and its time for a buttocks plastic surgery update!

From a cosmetic plastic surgeon’s perspective, there are three types of buttocks plastic surgery that can be performed: patients want their buttocks larger, smaller or just lifted.

A.

Making buttocks bigger

The options for making buttocks larger are:

1. Silicone implants

In this outpatient cosmetic procedure, a 2-3 inch incision is made between the buttock cheeks and a solid silicone implant is placed under the buttock (gluteus) muscles.

  • Silicone implants used are different from ones used in breast augmentation and are firmer to touch
  • Implant have to be placed higher in buttocks, as you cannot sit on implants for fear of rupture; we all sit on the bone under our buttocks
  • Healing takes about 10 days and full recovery 1-2 months

2. Fat injections – Brazilian buttock lift

  •  Even though the Brazilian buttock lift has “lift” in its name, it’s a plastic surgery procedure that both enlarges and lifts buttocks
  • Liposuction of abdomen and hips is performed, and harvested fat is injected into buttocks
  • I typically inject about 800 cc into each buttock at one surgery for maximum effect
  • This is an outpatient cosmetic surgery requiring 3-4 days for recovery and 1 month for full healing
  • About 30% of  fat injections will naturally disappear, but some will remain permanently; everyone is different

B.

Making the buttocks smaller

There is really only one cosmetic procedure to make buttocks smaller, and that is liposuction. In this procedure, three to four small incisions are made around either cheek and fat is removed, leaving behind a smaller buttock. The cosmetic danger is in removing too much fat and turning a plump cheek into a flat and droopy one—not a good idea.

C.

Lifting the buttocks

There are two options for this cosmetic procedure, buttock lift surgery and, again, Brazilian buttock lift.

Buttock lift surgery

In this surgery, a scar is placed in a crease under the cheeks and the skin is turned in to give a modest lift.

The problem is that the plastic surgeon is trying to push and hold your skin and fat tissues in a high position against gravity’s force; given the weight of skin and fat, gravity wins. The scars are not great from this surgery, and I try hard not to perform it!

Brazilian buttock lift 
As above, fat injection will not only make a buttock larger but will also lift it, in the same way an empty bag is “lifted“ when full. With liposuction I can actually change the shape of the buttocks to to make them larger and lifted or smaller and lifted!

The concept to keep in mind with all these surgeries is that by changing the shape of the skin and fat around an area I can change the apparent shape of the area itself!

The update

I first wrote this blog in 2010. $ years later not much has changed other than…

I now perform a lot more Brazilian buttock lifts than before; it is a routine procedure now.

I do very few silicone implants these days

I have not done a simple lift with cutting of the skin in 4 years! – It is just not a good surgery.

We still do not know how come much fat cells survive in some areas and not in others as well!

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.

Liposuction Seroma

 Seroma formation after liposuction

Liposuction is a procedure in which your board-certified cosmetic plastic surgeon can remove specific unwanted areas of fat from your body.

Here are is a blog post about liposuction, swelling and seroma:

https://tavmd.com/2013/03/17/lymphatic-drainage-after-cosmetic-surgery/

Arm liposuction photo

Complications of liposuction

As with any cosmetic surgery procedure, there are a number of complications that can occur after liposuction. Some lipo complications include:

  • infection
  • bleeding
  • uneven contour
  • loss of skin
  • liposuction seroma formation

 

Liposuction Seroma

Seroma is the name given to an accumulation of serum, or lymph, under the skin. Essentially, it is what causes the initial swelling in an area of the skin after an injury. In this case, it’s just that the swelling does not go away and continues to get larger, forming a seroma!

 

Seroma formation

After skin is injured by any form of trauma, a bump or a cut, blood vessels in the area become more permeable. This allows white blood cells and other blood protein factors necessary for the skin to heal to go out of blood vessels  and lymphatics and surround tissue cells to help in the repair process.

This fluid mixture is called lymph, and its accumulation is called a seroma.

In fact, there is a constant flow of lymph in and out of blood vessels, which is picked up by the lymphatics and taken back into blood circulation through specific points on the left side of the neck for the head and the groin for each side of the body.

Injury merely means there is more fluid going into the tissues than can be absorbed, leading to its accumulation as swelling or seroma.

With time, this fluid is absorbed back into the blood vessels once healing has occurred.

If the fluid cannot be absorbed fast enough after surgery because the vessels carrying lymph (lymphatics) have been cut, a seroma will form.

 

Seroma after liposuction

A main cause of seroma formation after liposuction is damage to the lymphatics by liposuction cannulas ( this is worse with laser and ultrasound injury) . The normal tissue response to injury also occurs, and more lymph and fluid pours into areas where lipo has been performed, causing swelling.

 

What to do with seroma

Once a seroma has formed, the fluid needs to be removed so the skin can stick back down. Seroma can either:

  • drain spontaneously
  • be resorbed spontaneously
  • be drained surgically

 

Spontaneous drainage

Spontaneous drainage is usually messy but is also efficient and typically occurs when a seroma is least expected. The skin over the seroma may not feel like it’s holding the clear yellow to brown liquid. It may just feel firm. Once spontaneous seroma drainage occurs, I tell my plastic surgery patients to encourage the drainage by expressing the fluid out. Keeping the area clean with hydrogen peroxide is also important.

Infection is a rare but possible complication of seroma, and both the patient and the plastic surgeon need to keep an eye out for it and treat it if it becomes apparent.

 

Resorption

Spontaneous resorption is a common occurrence for small seromas and probably occurs in all cosmetic plastic surgery procedures without the cosmetic patient or plastic surgeon even knowing about it.  One does not know about it, and so nothing needs to be done!

 

Surgical drainage of seroma

When the cosmetic plastic surgeon feels an accumulation of fluid under the skin, it is usually drained with a needle and syringe. In rare cases, drainage using a drain that stays in for a week or so may be necessary.

 

Compression after seroma

Wearing  compression garments for at least two weeks and, later on,  massage, will help move the fluid out of skin areas. The skin needs time to stick down to the underlying muscles and have a chance for the lymphatic vessels to heal together. During this healing phase, it is important to prevent shear forces on the skin, and exercise is not recommended.

So, when a seroma develops, get the fluid out, watch for signs of infection, wear a compression bandage and don’t exercise until the skin has adhered to the underlying tissue.

 

Morad Tavallali, M.D., FACS

Bulges After Abdominoplasty-Tummy Tuck

Bulges after abdominoplasty-tummy tuck  or liposuction surgery,  is not unusual for the cosmetic plastic surgery patient . There are multiple reasons for these bulges; some can be improved and others are normal sequel of cosmetic surgery.

Here are some previous posts about tummy tucks:

https://tavmd.com/2010/10/26/tummy-tuck-abdominoplasty-or-liposuction/

https://tavmd.com/2010/10/27/how-is-a-tummy-tuck-done/

abdominoplasty

 

 

 

 

Swelling

Normal post-operative swelling after abdominoplasty and liposuction may take up to four months to improve. Though the swelling is initially all over the abdomen and hips, as the patient moves around, the swelling will settle down in the area just above the tummy tuck scar of the pubis and cause a bulge. Lymphatic massage can help remove the swelling bulge.

Abdominal scar

The way the cosmetic plastic surgeon closes the scar of the abdomen will also lead to temporary bulges of the skin.

For a tummy tuck, the incision over the pubis is usually smaller than the incision of the upper part of the abdominal skin that is removed. The relative excess of skin in the upper parts of the abdomen means that the skin needs to be folded into the lower incision of the abdomen, causing small bulges of skin. If a longer incision is made in the pubic area, the bulges can be eliminated at the time of surgery, but at the expense of a longer abdominal scar. However, with a little patience, the bulges will flatten out and a straight scar can be achieved without making it longer.

 

Abdominal hernias

Patients who have tummy tucks and abdominoplasty by definition have a weakness of the abdominal wall muscles. This is what causes the roundness of the shape of the abdomen. With tummy tuck surgery, the muscles are tightened to give a flat abdominal contour. In some patients, the muscles themselves may be very thin and not strong enough to hold the abdominal contents, leading to hernias. These hernias require a specific and separate procedure for closure. Sometimes it can be performed at the same time as an abdominoplasty, but at times it may only become apparent after abdominoplasty and liposuction remove the fat covering the belly.

Excess fat

Some surgeons, such as myself, routinely perform liposuction at the same time as abdominoplasty surgery to get more contoured results. Other cosmetic plastic surgeons do not perform any liposuction with abdominoplasty, and still others perform it as a second procedure 6 to 12 months after the tummy tuck surgery.

With any liposuction it is possible to leave a little extra fat on one side or the other that may require a touch up later. The reasons for this are that patients have different amounts of fat on either side of the body and the tumescent solution injected for the liposuction swells the area up and makes it difficult for plastic surgeons to achieve a symmetrical result.

 

Scoliosis

The curvature of the spine called scoliosis, which many of us have, leads to the appearance of bulges on the abdomen only because of the way we stand. There is the same amount of fat on the abdomen on the two sides, no hernias or skin fold, just a curvature of the spine that makes the body curve to one side and cause an apparent bulge!

The causes for bulges after abdominoplasty and liposuction are many but can be identified and corrected with a little patience.

Morad Tavallali, M.D., FACS

Cost of Plastic Surgery: Nickel and Diming Cosmetic Patients

Cost of tummy tuck surgery increases with technology

 

We live in an age of exponential growth in information and technology and in the cost of surgery. Even in the past few years, advances in cosmetic plastic surgery techniques have been enormous—and so has the cost of surgery! Some cosmetic plastic surgeons still cling to old methods. That is sad.

Here are a few other posts on these topics:

https://tavmd.com/2012/02/24/plastic-surgery-without-pain/

https://tavmd.com/2011/07/02/new-technique-for-tummy-tuck/

dollar sign

New surgery techniques  come with  a higher cost. How to deal with an increase in the cost of surgery in an era when we are all trying to keep surgery costs down is problematic.

As a cosmetic plastic surgeon, I have a certain cost for my surgeries. Regularly, costs of implants and garments are added to  costs for surgery in addition to hospital/anesthesia fees. Think of it as the cost of performing surgery + materials.

 

Exparel

I have previously written about Exparel.  This slow-release formulation of a common local anesthetic (Bupivacaine) that many plastic surgeons use is set to explode on the market and change the way we practice medicine. The drug  provides for a three-day area of numbness when injected into the surgical field. That means three days of reduced need for narcotics (with all of its problems), not suffering pain and getting back to normal faster!

It adds $285 to the cost of surgery (breast augmentation or tummy tuck).

The hospital doesn’t provide it to plastic surgeons; they do provide regular bupivacaine as part of a global surgery cost. What do they care if you have less pain once you are out the door?  They don’t save any money.

This leaves cosmetic plastic surgeons with the sad choice of telling cosmetic patients that a drug exists that will reduce their pain but add to the cost of surgery. Patients can then choose whether to buy it or not. First-class ticket or economy? I find it hard to practice medicine knowing that a better alternative exists for my patient but that it will not be offered due to cost. That just seems wrong. Reduce my fee and eat the cost? OK; but by the same token why not increase my fee and include Exparel?

Prineo

This is a new wound closure system from  the Ethibond suture company. The combination of Dermabond (tissue glue) and tape makes for a far superior dressing after surgery that stays on patients for about one month. Scars are rare because it decreases incision and tension on the skin for most patients.

My surgery center used to provide it as part of the hospital fee. Not anymore.  I have to either abandon what I know to be a far better closure system and go back to the old, lesser techniques… or have patients pay an extra $250.

Liposuction

For my abdominoplasty/tummy tuck patients, I regularly include abdominal and hip liposuction. It turns out that many plastic surgeons do not include  liposuction, and if they do, they charge patients extra for it… like I used to!

I used to offer patients the option of liposuction at the same time as abdominoplasty because I knew that the cosmetic results were better.  Most would say “no thanks”—the cost was another 20% on top of  tummy tuck fees and that turned out to be too much for most patients. Those who had the liposuction at the same time were happy, and the ones who did not returned later to have it or left unsatisfied despite my best efforts to forewarn them.

I have decided to include the liposuction in all my abdominoplasty operations as standard. I had to cut my fee down for the lipo, but I now get better results. I was able to do this because it was my work and time, not a fixed cost of materials from another company.

Medical economics

The above gives you an example of how the cost of plastic surgery continually rises advances in technology.  New medical advances cost money, which is usually transferred to the patient’s insurance company, which may or may not pay for particular therapies.

In cosmetic surgery patients who pay out of pocket, a new/better treatment modality will cost more. As a cosmetic plastic surgeon, I want the best possible results for my patients, but now I have to offer them a choice between the “best” techniques and simply “good” ones.  If I keep on eating the cost, eventually I will be performing the surgery for free, as my costs will be greater than my income. After all, this is how I make my living.

I can’t decide what to do! I fear that increasing the cost of plastic surgery without telling patients the reasons will frighten away patients who may not understand the nuances of surgery and differences in results.

Or should I be offering a two-tier surgical result—a basic economy tummy tuck and a first-class tummy tuck with all the extras ? Advice is welcome—only first-class advice at no extra cost please!

Morad Tavallali, M.D., FACS