Category Archives: THIGH LIFTS

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

Thigh Lift Surgery after Weight Loss

Thigh lifts for non-droopy thighs

 

A Thigh Lift Surgery after Weight Loss is a cosmetic procedure in which excess thigh skin is removed and the remaining thigh skin lifted, is common after weight loss.

Though many other body areas seem to bother patients who have had massive weight loss more, eventually, after their tummy tuck, breast lift with or without enlargement via implants and arm lift comes the thigh lift. Still, last year, the number of thigh lifts performed in the US dropped 27% compared with 2011. Reason unknown.

Here are some articles about how to correct other droopy areas like buttocks and arms:
https://tavmd.com/2011/10/22/droopy-buttocks-away/
https://tavmd.com/2010/12/01/buttocks-plastic-surgery/

The main issue facing weight loss patients is that skin becomes loose and loses elasticity. Skin droops. It droops in the belly, breasts, arms, buttocks and thighs.
In the thigh area, skin drooping is common in three regions:

  • Anterior thigh – the skin in the front that droops over the knees
  • Inner thigh – skin drooping in inner thighs that is unsightly
  • Posterior thigh – skin under buttocks

A thigh lift  may address all or just one of these areas.

Here are some before and after photos of thigh lifts:

 

Thighs before surgery

After thigh lift surgery

Before thigh lift surgery

After thigh lift surgery through groin incisions

Thigh lift surgery

Techniques for performing thigh lifts are based on your plastic surgeon’s training as well as your own wishes. I have always thought that techniques where vertical cuts are made on the inner side of the thighs and arms for “lifting” them are useless. These horrible vertical scars do not lift anything. They may make the limb smaller in diameter, but at the cost of an unsightly visible scar that is too much for me. After all, plastic surgery patients want to wear shorts or short-sleeved shirts. With a long scar, that is not possible.

My preferred technique is a horizontal groin scar. It starts in the groin crease in front and follows the crease backwards where it lies in the buttocks crease. In this way, your scar is hidden and you can wear shorts.
Markings for skin excisions are made. Surgery begins with a thigh liposuction to remove excess fat and make the thighs smaller. Excess skin is then excised. Strong sutures are used to secure the heavy thigh skin to the underlying groin area tissues and the skin is closed with multiple suture layers. Heavy thigh skin will have a tendency to try to pull scars down, and securing high up skin is important. Nevertheless, some drooping of the scar with time is inevitable and should be anticipated.


Complications of thigh lifts

As with any cosmetic procedure, complications can occur:

  • Infection – rare. Patients will need to take antibiotics prophylactically.
  • Bleeding – rare. I typically do not use drains for this surgery.
  • Wound separation – common. Almost all patients will have some opening of the wound. Due to the location of the scars, the moment a patient sits down there is tension on the scar and wounds can open. Treatment usually involves cleaning wounds and packing them with gauze. Wound openings typically heal themselves. Future scar revisions may be necessary after wound healing is complete.
  • Difficulty walking – common. Due to the location of the incisions, walking is a bit difficult for the first few days after surgery. No exercise is allowed for several weeks.


As compared to so many other cosmetic surgery procedures I perform, recovery from a thigh lift is, in my opinion, one of the more difficult recoveries. Recovery from a tummy tuck may initially be more painful due to muscle cramps, but it is short-lived; with breast surgery, it may take longer for final results to appear; however, a thigh lift is the one cosmetic procedure that really requires a motivated and well-informed patient. It does not hurt much, but it does take a long time to heal and requires more wound care.


However, for patients who really need and want it, a thigh lift opens possibilities for wearing shorts and miniskirts again and gives cosmetic plastic surgery patients the confidence to show off one of the few body parts that is acceptable to display in many parts of the world. Now, that’s worth an arm and a leg.

Psychology of Weight Loss Changed by our Environment

Where you sit affects your weight loss for diets

 

Readers of this blog are familiar with my particular and specific interest of the boundaries of psychology and cosmetic plastic surgery. Here is a new nugget to put on your table when trying to lose weight. See my previous post about weight loss diets:

https://tavmd.com/2012/01/20/eating-with-our-eyes/

In my post above, I describe experiments affecting weight loss. Size of plates (obviously), color of food  (!), contrast between plate and place mat (!!)—these things all affect our eating behaviors. How we arrange our physical world changes our intake of food. Your intake can be lessened or increased, depending on where you want to be on a weight scale. Being told that we are eating a large portion will make us eat less and leave food on the plate, while being told it is a small portion will invariably lead to all  food being eaten—in the experiment, the amount of food on the plates was equal in each case!

The latest research shows that our eating habits can further be influenced by our immediate physical surroundings and by not-so-subliminal references to our weight. Weight loss is affected by where we sit!  Psychology of Weight Loss Changed by our Environment.

 

Eating habits affected by photos

 

In a study conducted in Switzerland, researchers placed test subjects in a room with chocolates and asked them to fill out some evaluation forms about the taste. After all, these were Swiss chocolates! Subjects were free to eat as many as they wanted. Half of them were in a room with a computer screen showing a photo of Giacometti sculptures—tall, narrow, anorexic human figures the Swiss sculptor is famous for. The other half was in a room with an abstract  photo of a painting by Mark Rothko on the screen. Which group ate more chocolates?  That’s right (pretend, even if you got this wrong): the group with the Rothko painting in the room ate more. Subjects in the Rothko painting room ate an average of 6.4 pieces of chocolate, while those in the Giacometti thin human form room averaged 4.7.

Rothko watchers eat more

 

rothko

 

 

 

 

 

 

 

Giacometti

Giacometti watchers eat less

 

 

 

 

 

 

 

 

 

 

 

Most importantly, a majority of  participants did not even notice the photos on the screens—on a conscious level. They did notice them on a subconscious level, however, in their peripheral vision, and it seems that this was enough to make them eat less. Why?

It could be that the thin Giacometti figures remind us of being thin, and eating chocolate is associated with getting fat. Or is it guilt that tells us not to eat too much when there are hungry-looking people around? Any ideas about this weight loss method?

 

Eating affected by recording weight

 

In another Swiss research study also involving chocolates, two groups were given questionnaires to fill out that included information about age, sex and weight. One group filled out the questionnaires before tasting the chocolates, the other after tasting. My paragraph title already gives you a clue as to what happened. Those who wrote their weight down before the tasting ate less than those who ate chocolates and then wrote down their weight and other vital statistics at the end. Except for men, that is! Women ate less when indicating their weight, but not men. I  don’t know why. Maybe it has to do with the particular sensitivity women in Western societies have regarding their weight—something men as a group do not have. There are far fewer men on diets than there are women concerned with their weight and on weight loss programs.

To be fair, it has to be noted that these experiments used Swiss chocolate, which is particularly tempting. Nevertheless…

Morad Tavallali, M.D., FACS