Tag Archives: LIPOSUCTION

Fat injections for breast enlargement

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Fat Injections to Breasts

 

I have previously written about fat injections for breast enlargement but new information keeps on coming up and cosmetic plastic surgery patients continue to show interest in this plastic surgery procedure. here are photos from an article in the Aesthetic Surgery Journal of March 2014 by Drs. Spear and

 

Breast augmentation with fat injections Breast augmentation with fat injections

Breast Enlargement with implants

The traditional methods of breast enlargement by either placement of saline or silicone breast implants under the chest muscles have been performed by board certified plastic surgeons since the late 1960 s.  Breast augmentation surgery has withstood the test of time. The surgery will produce consistent results and has a 98% satisfaction rate amongst patients.

Multiple variations of breast sizes and shapes are possible now that moderate profile implants, moderate -plus sized implants, and high profile implants are available from multiple breast implant manufacturers. These implants satisfy the needs of patients who typically are looking for at least a 2 cup size increase in their breasts.

Breast implants are foreign objects for the body and will form capsules of scar tissue around them which can become problematic at time. The implants can also break or rupture and in general need upkeep.

100% of patients will get a substantial improvement in breast size that is long lasting. Breast surgery with implants takes one hour.

Breast Enlargement wit Fat injections

In order not to have the problems that implants can sometimes cause, fat injection to the breasts has been advanced as an alternative surgery by some plastic surgeons.

Fat is removed by liposuction from one area of the body and injected into the breasts to enlarge them. Breasts are made up of a combination of breast glandular tissues and fat. Breast enlargement with fat injections adds to the fatty tissue already there.

Advantages of breast augmentation with fat injections

  1. Natural tissue and feel of breasts

Disadvantages of breast augmentation with fat injections

  1. Un-predictable loss of  breast volume- some of the fat always dies after a fat transfer. How much will die is unpredictable despite multiple techniques for handling and injection of the fat. Typically the latest study shows that only 30% – 40% of the fat injected remains within 6 months.
  2. Risk of development of breast cancer – The fat that is injected will have stem cells which when in the vicinity of breast tissue could cause breast cancer. This has been shown to occur in animal models. Even the latest plastic surgery article about breast enlargement with fat injections mentions that patients should be counselled about the risk of developing breast cancer!
  3. Small volume of breast enlargement possible.  In general breast augmentation achieved with fat injections only gives one cup enlargement of the breast. Typically about 250 cc fat is injected.  Within a few months after surgery only 30- 40 % of the fat remained. How much of that actually stays long term is unknown.
  4. Longer operative time. Typically surgery took 3 hours for fat injections.
  5. 10% of patients have substantial improvement in breast size, and 50% have a moderate improvement in breast size.

So,

Breast enlargement with fat gives minimal improvement in breast size ,has un-predictable results, of unknown duration, requiring three times longer surgery, and increases the risk of breast cancer.

No thanks- I’ll stick to implants for now.

 

 

 

Tummy tuck scars

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Abdominoplasty tummy tuck scars in wrong location

Often a picture is worth a thousand words.

Look here;

High abdominoplasty scar

 

This young patient came to see me after having had an abdominoplasty – tummy tuck surgery by another plastic surgeon. It’s not the first time I see this type of scar after a tummy tuck on a patient. Unfortunately it is far too common and worst of all, in many situations little can be done to fix it by any cosmetic plastic surgeon. The scar is just too high and the plastic surgery patient cannot cover it up even with larger style of panties.

 

Abdominoplasty scar too high

 

 

Reasons why tummy tuck scars are too high

  1. Easier surgery for surgeon

The sad fact is that some board certified plastic surgeons are lazy and do not wish to have any headaches with their surgical procedures even at the cost of a shoddy surgical result.

Placement of the tummy tuck scar high on the abdomen means that the surgeon has

  • less work to do,
  • the work he does perform is easier,
  • the risk of any wound opening or scar disruption is less
  • the patient will have less pain as there is less tension in the abdomen.

It also means that the patient will have

  • a lesser result
  • an unsightly scar forever.

       2.  Easier for the plastic surgery patient

The high scar means there is less tension on the wound and  also a better blood supply. Unfortunately trying to get away with an easy surgery, less pain, and less risk, though something we all want, is not going to give you the result you want. In fact it will give you a result you will hate and regret. Not what we want plastic surgery to do for you!

Many plastic surgery patients who have been to doctors in other countries to have surgery will return with these types of tummy tuck scars. I cannot blame them. They have a medical tourist who is going to be around for a short period of time and who wants a quick fix.  The plastic surgeon will not be there to give post-operative care and does not want any headaches- so, a high scar solves his problem. By the time the plastic surgery patient realizes where the scar is and that it cannot be hidden by normal panties, it is too late and the patient has long left the country.

In summary, for the best surgical results after a tummy tuck the scar should be as low as possible just above the pubic area. Though this may mean that scars may have some small disruption in the early post operative period, they can always be fixed later. The high abdominal scar can rarely be fixed if ever.

 

Mommy makeover-Breast-Abdomen plastic surgery

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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.

Decreased swelling after tummy tuck

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How to decrease swelling after Tummy tuck

Tummy tuck or abdominoplasty is a common cosmetic surgery procedure. The cosmetic plastic surgeon tightens muscles of the abdomen, remove extra tummy skin,  and liposuction of the flank for fat removal.

Here are a few previous blogs on the topic.

 https://www.tavmd.com/2013/02/17/full-or-mini-abdominoplasty/

https://www.tavmd.com/2011/03/13/abdominoplasty-after-care-part-1/

https://www.tavmd.com/2011/03/17/abdominoplasty-after-care-2/

Healing after an abdominoplasty or tummy tuck is dependent on a number of factors

1. Amount of fat and thickness of skin

2. Patient genetics and lymphatic tree

3. Movement of the body

 

Skin and fat

The more skin and fat a patient has the greater the amount of “water” (swelling)  that is trapped within the abdomen . This will prolong the time for the swelling to decrease. Thinner patients will have a faster recovery from swelling after a tummy tuck. There is not much a patient can do about that after the surgery, but it’s important  for you to know.

 Lymphatic vessels

The lymphatic vessels are responsible for removal of the swelling from the tissues and taking it back to the blood circulation. The lymphatics mirror the blood vessels throughout the body. Any damage to the lymphatics,( surgery can be considered an injury), will decrease lymphatic flow.  Decreased lymphatic flow causes more swelling. With time lymphatic vessels reform and start their function again. Until this time, massage of skin by lymphatic massage, will help to decrease swelling in skin.

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

 Movement

Another way to decrease swelling after a tummy tuck is for the cosmetic plastic surgery patient to move. Walking or even standing are better than sitting. Sitting will increase swelling in the lower abdomen which needs even more time for healing.  Even movement of the limbs will help decrease swelling in the abdomen also as the lymphatic system is a closed system.

 https://www.tavmd.com/2010/10/22/blood-clots-and-tummy-tucks/

Morad Tavallali, M.D., FACS

Seven Deadly Sins in the US and Plastic Surgery

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What the seven sins tell us about plastic surgery

One of my particular interests is the point where theology, psychology and health meet cosmetic plastic surgery. I have written about the seven deadly sins in the past;

https://www.tavmd.com/2011/09/22/the-sin-of-plastic-surgery/

http:/www.tavmd.com/2013/09/01/gluttony-why-america-is-fat/

 

Here is a map someone forwarded to me from Deadly Panda, which seems to produce some rather interesting maps.

The map shows the distribution of the seven deadly sins across the United States. Areas in red are “devilish,” those in green “saintly.”

7-deadly-sins

Greed

Greatest in the big cities. From Boston and New York to D.C., Los Angeles and Chicago to Seattle. Not too surprising. They did not examine the greed that some plastic surgery patients exhibit with too many plastic surgery procedures, too much Botox and too many fillers. Some women from these cities can be considered greedy when it comes to plastic surgery.

Envy

Overall, the rate of theft appears to be greatest in the South. Envy of others’ beauty, breast size or abdominal six pack was not measured.

Wrath

Murder rates are greatest in the South, New Mexico, Louisiana and Northern California . . . those boys at the bayou must not be so easygoing after all.

Sloth

Expenditure on “unnecessary” things is greatest in the Dakotas and Montana. This shows that expenditure on plastic surgery was not considered a sin by the producers of this map, as cosmetic surgery rates in these states are rather low.

Gluttony

The map displays the number of fast food restaurants per capita—not really my definition of gluttony. The number of expensive restaurants per capita would be a better indication. These areas in no way correspond to areas with the highest liposuction rates in the US, proving that gluttony does not necessarily make you fat.

Lust

The southern and eastern seaboards seem to have a preoccupation with sex. At least, that’s what the distribution of sexually transmitted disease cases seems to imply. Of course, it may be that the rest of the country is equally obsessed but simply has better doctors!

The larger average breast implant size in the South may have something to do with this phenomenon.

Pride

As the aggregate of the other sins, pride seems to be greatest across the south of the country. Consider, though, that it may be pride in their beautiful bodies!

Now that was interesting, wasn’t it?

 

Morad Tavallali, M.D., FACS

Tummy Tucks for Men

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 Abdominoplasty in male cosmetic plastic surgery patients

 

Abdominoplasty, or tummy tucks for men, is a procedure that is often performed on women, and most of my blogs have talked about female cosmetic plastic surgery patients having these procedures.

https://tavmd.com/2013/02/17/full-or-mini-abdominoplasty/

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

Tummy tucks can also be performed on males, and though the number of male cosmetic plastic surgery patients who need an abdominoplasty is significantly less than female patients, there is no substitution for this surgical procedure when it’s necessary.

 david chubby photo    tavmdphoto1_ezg_1

Tummy tucks for men

Reasons for a male to have an abdominoplasty differ from abdominoplasty in female cosmetic patients.

Typically females will have abdominoplasty for:

  • Excess loose skin
  • Excess fat
  • Separation and weakness of abdominal muscles

 

Males obviously do not have the sequelae of pregnancy to deal with and so do not have the separation of abdominal muscles that is a major reason for female abdominoplasty. They can, however, have extra fat and skin looseness.

Significant weight loss is the main reason for male tummy tucks.

 

Surgery techniques for abdominoplasty in men

Techniques for abdominoplasty in general include:

  • Excision of extra skin in the abdomen
  • Liposuction of fat from the abdomen, flanks and love handles
  • Suturing of abdominal rectus muscles

 

In male tummy tucks, liposuction and the excision of skin between the umbilicus, belly button, and pubic areas is performed in the same way as in female abdominoplasty.

The main difference is in the type of abdominal rectus muscle plication performed.

For female patients, I tighten the abdominal muscles in a diamond shape to bring the waist line in to a pre-pregnancy form and emphasize a small waist.

When men have tummy tucks, the idea is to tighten the muscles, if necessary, into a V shape, not to give them a small waist. This tightening of muscles is performed in a vertical manner.

The recovery from an abdominoplasty/tummy tuck  for men tends to be less difficult than for women because less tightening of the abdominal muscles is required. Men are typically able to resume work after 7-10 days.

 Still, the great majority of men looking for improvement in their abdominal contour and tummy shape will benefit from just a liposuction, without any removal of extra skin or a tummy tuck.  Many male tummy tuck patients also benefit from liposuction of the chest to reduce gynecomastia.

 

 

 

Morad Tavallali, M.D., FACS

Liposuction Seroma

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 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