Procedures - Body Plastic Surgery

Arm Lift/Brachioplasty

An arm lift, also known as brachioplasty, is a surgical procedure to remove loose skin and excess fat deposits in the upper arm. With age, weight loss and gain or just as result of heredity upper arm skin can become loose and flabby. In some cases your plastic surgeon may suggest that liposuction be used alone or in conjunction with an arm lift to remove excess fat in the upper arms. Their are various types of upper arm lifts depending upon the extent of the fat excess and looseness of the skin.

The best candidates for liposuction are normal-weight people with firm, elastic skin who have excessive fat in their upper arms. You should be physically healthy, psychologically stable and realistic in your expectations. Older patients may have diminished skin elasticity and may not achieve the same results as a younger patient with tighter skin.

Brachioplasty carries greater risk for individuals with medical problems such as diabetes, significant heart or lung disease, poor blood circulation, or those who have recently had surgery near the area to be contoured. You may require pre-operative medical clearance prior to surgery.

There are several Brachioplasty techniques that can be used to improve the ease of the procedure and to enhance outcome. Each technique is dependent upon the extent of excessive skin present in the upper arm. Some procedures can leave scars all the way down your medial upper arm or elbow. Liposuction can be performed as an adjuvant to the upper arm lift.

Brachioplasty & Liposuction are normally safe, as long as patients are carefully selected, the operating facility is properly equipped and the physician is adequately trained. As a minimum, your surgeon should have basic (core) accredited surgical training with special training in body contouring. Also, even though many body contouring procedures are performed outside the hospital setting, be certain that your surgeon has been granted privileges to perform these procedures at an accredited
hospital.

The scars from Brachioplasty are usually strategically placed to be hidden from view. Newer techniques attempt to hide the scar in patients arm pit area. But remember, these scars are permanent. Recovery is a bit longer with the upper arm lift because the incision is in a location of motion. If you are considering a Brachioplasty and/or Liposuction of the upper arm then consider the Iris Surgery Center and Dr. Gary R. Culbertson.

Liposuction/Fat Grafting

Liposuction is a surgical procedure that can help sculpt the body by removing unwanted fat from specific areas, including the abdomen, hips, buttocks, thighs, knees, upper arms, chin, cheeks and neck. During the past decade, liposuction, which is also known as “lipoplasty” or “suction lipectomy,” has benefited from several new technological refinements. Today, a number of new techniques, including ultrasoundassisted lipoplasty (UAL), the tumescent technique, laser assisted and irrigation techniques, are helping many plastic surgeons to provide selected patients with more precise results and quicker recovery times. Although no type of liposuction is a substitute for dieting and exercise, liposuction can remove stubborn areas of fat that don’t respond to traditional weight-loss and toning methods. Areas of excessive skin may have to be removed at the time of your procedure.

To be a good candidate for liposuction, you must have realistic expectations about what these procedures can do for you. It’s important to understand that liposuction can enhance your appearance and self confidence, but it won’t necessarily change your looks to match your ideal or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your plastic surgeon. The best candidates for liposuction are normal-weight patients with firm, elastic skin who have pockets of excess fat in certain areas. You should be physically healthy, psychologically stable and realistic in your expectations. Your age is not a major consideration; however, older patients may have diminished skin elasticity and may not achieve the same results as a younger patient with tighter skin. Liposuction carries greater risk for individuals with medical problems such as diabetes, significant heart or lung disease, poor blood circulation, or those who have recently had surgery near the area to be contoured.

In your initial consultation, your surgeon will access your health, determine where your fat deposits lie and assess the condition of your skin. Your surgeon will explain which of the various body-contouring methods that may be most appropriate for you. For example, if you believe you want liposuction in the abdominal area, you may learn that an abdominoplasty or “tummy tuck” may more effectively meet your goals especially if you have multiple pregnancies; or that a combination of traditional liposuction and UAL would be the best choice for you. Be frank and honest in discussing your expectations with your surgeon. He or she should be equally frank with you, describing the procedure in detail and explaining its risks and limitations. Individuals considering liposuction often feel a bit overwhelmed by the number of options and techniques being promoted today. However, this is where your plastic surgeon can help. In deciding which is the right treatment approach for you, your doctor will consider
effectiveness, safety, cost and appropriateness for your needs. This is called surgical judgment, a skill that is developed through surgical training and experience. Your doctor also uses this judgement to prevent complications; to handle unexpected occurrences during surgery; and to treat complications when they occur.

For men, common sites for liposuction include under the chin and around the waist. Liposuction may also be used in the reduction of enlarged male breasts, a condition known as gynecomastia. Often in the female patient the best candidates for liposuction are of normal weight with localized areas of excess fat– for example, in the buttocks, hips, and thighs.

The time required to perform liposuction may vary considerably, depending on the size/location of the area, the amount of fat being removed, the type of anesthesia and the technique used. Liposuction is a procedure in which localized deposits of fat are removed to re-contour one or more areas of the body. Through a small incision, a narrow tube or cannula is inserted and used to vacuum the fat layer that lies deep beneath the skin. The cannula is pushed then pulled through the fat layer, breaking up the fat cells and suctioning them out. The suction action is provided by a vacuum pump or a large syringe, depending on the plastic surgeon’s preference. Sometimes ultrasound, laser or fluid is utilized to break up areas of the localized fat. Fluid is lost along with the fat, and it’s crucial that this fluid be replaced during the procedure to prevent shock. For this reason, patients need to be carefully monitored and receive intravenous ( IV ) fluids during and immediately after surgery. A snug compression garment worn immediately after surgery helps reduce swelling and bruising. Improvement will become apparent after surgery but it may take about six weeks, when most of the swelling has subsided to get a better idea of your result.

Fluid Injection, a technique in which a medicated solution is injected into fatty areas before the fat is removed, is commonly used by plastic surgeons today. The fluid — a mixture of intravenous salt solution, lidocaine (a local anesthetic) and epinephrine (a drug that contracts blood vessels) – helps the fat be removed more easily, reduces blood loss and provides anesthesia during and after surgery. Fluid injection also helps to reduce the amount of bruising occurring after surgery. The amount of fluid that is injected varies depending on the preference of the plastic surgeon. Large volumes of fluid — sometimes as much as three times the amount of fat to be removed — are injected in the tumescent technique. Tumescent liposuction performed only with local anesthesia usually takes significantly longer than traditional liposuction (sometimes as long as 4 to 5 hours). The super-wet technique is similar to the tumescent technique, except that lesser amounts of fluid are used. Usually the amount of fluid injected is equal to the amount of fat to be removed. This technique often requires IV sedation or general anesthesia and typically takes one to two hours of surgery time. Ultrasound Assisted Lipoplasty (UAL). This technique requires the use of a special cannula that produces ultrasonic energy at the tip. As it passes through the areas of dense fat, the energy explodes the walls of a more proportional removal of fat. Laser assisted liposuction functions in a similar fashion as UAl. The laser assist to rupture fat cells allowing for the easy removal of the fat deposits, usually with less bruising. The fat is then removed with the traditional liposuction technique. UAL and Laser Liposuction have been shown to improve the ease and effectiveness of liposuction in fibrous areas of the body, such as the upper back or the enlarged male breast. They are also commonly used in secondary procedures, when enhanced precision is needed. In general, UAL and Laser Liposuction take longer to perform than traditional liposuction.

Liposuction is normally safe, as long as patients are carefully selected, the operating facility is properly equipped and the physician is adequately trained. Your surgeon must have advanced surgical skills to perform procedures that involve the removal of a large amount of fat (more than 5 liters or 5,000 ccʼs). Also, more extensive liposuction procedures require attentive after-care.

Imperfections in the final appearance are not uncommon after lipoplasty. The skin surface may be irregular, asymmetric or even “baggy,” especially in the older patient. Numbness and pigmentation changes may occur. Sometimes, additional surgery may be recommended to remove excessive skin or fat.

After surgery, you will likely experience some fluid drainage from the incisions. Occasionally, a small drainage tube may be inserted beneath the skin for a couple of days to prevent fluid build-up called a seroma. To control swelling and to help your skin better fit its new contours, you may be fitted with a snug garment to wear over the treated area for a few weeks to a month. Healing is a gradual process. Your plastic surgeon will probably tell you to start walking around as soon as possible to reduce swelling and to help prevent blood clots from forming in your legs. You will begin to feel better after about a week or two and you should be back at work within a few days following your surgery. Activity that is more strenuous should be avoided for about a month as your body continues to heal. Although most of the bruising and swelling usually disappears within three weeks, some swelling may remain for six months or more.

You will see a noticeable difference in the shape or contour of your body quite soon after surgery. However, improvement will become even more apparent after about four to six weeks, when most of the swelling has subsided. After about three months, any persistent mild swelling usually disappears and the final contour will be visible.

Lateral or Medial Thigh Lifts

A Thigh/Buttox Lift is a major surgical procedure to remove excess skin and fat from the lateral/posterior thigh and buttox. Often the tissue can be used as an augmentation to a flat buttox. The procedure can dramatically reduce the sag of the lateral thigh and buttox that often accompany significant weight loss. But bear in mind, it does produce a permanent scar, which, depending on the extent of the original problem and the surgery required tocorrect it, can extend from hip to hip. Often it is incorporated into the abdominoplasty scar. This not a minor procedure. It represents one of the major aesthetic procedures with associated major risks. Plan to take some time off if you are considering this procedure.

The best candidates for Thigh/Buttox Lift are men or women who are in relatively good shape but are bothered by a large fat deposit or loose thigh/buttox skin that won’t respond to diet or exercise. The surgery is particularly helpful to massive weight loss or gastric by-pass patients. Loss of skin elasticity in older patients, which frequently occurs with slight obesity, can also be improved.

Patients who intend to lose a lot of weight should postpone the surgery. Also, women who plan future pregnancies should wait. If you have had a gastric bypass procedure make sure your weight has stabilized before you undergo this procedure.

An Thigh/Buttox Lift is a cosmetic/aesthetic procedure not covered by insurance carriers. Thousands of Thigh/Buttox Lifts are performed successfully each year. When done by a qualified plastic surgeon who is trained in body contouring, the results are generally quite positive. Nevertheless, there are always risks associated with surgery and specific complications associated with this procedure. Post-operative complications such as infection and blood clots are rare, but can occur. Infection can be treated with drainage and antibiotics, but will prolong your hospital stay. You can minimize the risk of blood clots by moving around as soon after the surgery as possible. Poor healing, which results in conspicuous scars, may necessitate a second operation. Smokers should be advised to stop, as smoking may increase the risk of complications and delay healing. Do not have this surgical procedure if you cannot stop smoking.

Complete Thigh/Buttox Lift usually takes three to five hours, depending on the extent of work required. Most commonly, the surgeon will make a long incision from hipbone to hipbone. Next, the surgeon separates the skin from the thigh, back and buttox areas. Sometimes this tissue is used as a graft to accentuate the buttox. The lateal thigh and buttox are then lifted and excessive skin is removed.

Pain pumps are not commonly placed. Depending on the extent of the surgery, you may be released within a few hours after surgery, stay overnight or, you may have to remain hospitalized for two to three days. It is important to have someone to care for you in the postoperative period. You could require assistance for 3 to 5 days postoperatively. It may take you weeks or months to feel like your old self again. If you start out in top physical condition, recovery from a Thigh/Buttox Lift will be much faster. Some people return to work after two weeks, while others take three or four weeks to rest and recuperate. A Thigh/Buttox Lift produces excellent results for patients with excess skin. And in most cases, the results are long lasting, if you follow a balanced diet and exercise regularly.

If you’re realistic in your expectations and prepared for the consequences of a permanent scar and a lengthy recovery period, a Thigh/Buttox Lift may be just the answer for you.

Tummy Tuck/Abdominoplasty

Abdominoplasty, known more commonly as a “tummy tuck,” 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. But bear in mind, it does produce a permanent scar, which, depending on the extent of the original problem and the surgery required to correct it, can extend from hip to hip. This not a minor procedure. It represents one of the major aesthetic procedures with associated major risks. Plan to take some time off if you are considering this procedure.

The best candidates for abdominoplasty are men or women who are in relatively good shape but are bothered by a large fat deposit or loose abdominal skin that won’t respond to diet or exercise. The surgery is particularly helpful to women who, through multiple pregnancies, have stretched their abdominal muscles and skin beyond the point where they can return to normal. Loss of skin elasticity in older patients, which frequently occurs with slight obesity, can also be improved.

Patients who intend to lose a lot of weight should postpone the surgery. Also, women who plan future pregnancies should wait, as vertical muscles in the abdomen that are tightened during surgery can separate again during pregnancy. An abdominoplasty is a cosmetic/aesthetic procedure not covered by insurance carriers. A panniculectomy is not an abdominoplasty. A panniculectomy is the simple removal of the excessive skin of the lower abdomen. It is not an cosmetic/aesthetic procedure. Results are extremely different from those of an abdominoplasty. An abdominoplasty often includes tightening of the abdominal wall, liposuction and contouring of the abdomen and belly button. A panniculectomy is not an abdominoplasty. The results are entirely different.

Thousands of abdominoplasties are performed successfully each year. When done by a qualified plastic surgeon who is trained in body contouring, the results are generally quite positive. Nevertheless, there are always risks associated with surgery and specific complications associated with this procedure. Post-operative complications such as infection and blood clots are rare, but can occur. Infection can be treated with drainage and antibiotics, but will prolong your hospital stay. You can minimize the risk of blood clots by moving around as soon after the surgery as possible. Poor healing, which results in conspicuous scars, may necessitate a second operation. Smokers should be advised to stop, as smoking may increase the risk of complications and delay healing. Do not have this surgical procedure if you cannot stop smoking.

Complete abdominoplasty usually takes two to five hours, depending on the extent of work required. Partial abdominoplasty may take an hour or two. Most commonly, the surgeon will make a long incision from hipbone to hipbone, just above the pubic area. A second incision is made to free the navel from surrounding tissue. With partial abdominoplasty, the incision is much shorter and the navel may not be moved, although it may be pulled into an unnatural shape as the skin is tightened and stitched. Next, the surgeon separates the skin from the abdominal wall all the way up to your ribs and lifts a large skin flap to reveal the vertical muscles in your abdomen. These muscles are tightened by pulling them close together and stitching them into their new position. This provides a firmer abdominal wall and narrows the waistline. Artifical mesh may be required to reinforce and produce a flat abdominal wall.

The skin flap is then stretched down and the extra skin is removed. A new hole is cut for your navel, which is then stitched in place. Finally, the incisions will be stitched, dressings will be applied, and a temporary tube may be inserted to drain excess fluid from the surgical site.

In partial abdominoplasty, the skin is separated only between the incision line and the navel. This skin flap is stretched down, the excess is removed, and the flap is stitched back into place. Pain pumps are now commonly placed to decrease post operative pain. Depending on the extent of the surgery, you may be released within a few hours after surgery after surgery, stay overnight or, you may have to remain hospitalized for two to three days. Female patients relate that the post operative pain is similar to an abdominal hysterectomy. It is important to have someone to care for you in the post operative period. You could require assistance for 3 to 5 days postoperativily. It may take you weeks or months to feel like your old self again. If you start out in top physical condition with strong abdominal muscles, recovery from abdominoplasty will be much faster. Some people return to work after two weeks, while others take three or four weeks to rest and recuperate. Abdominoplasty, whether partial or complete, produces excellent results for patients with weakened abdominal muscles or excess skin. And in most cases, the results are long lasting, if you follow a balanced diet and exercise regularly.

If you’re realistic in your expectations and prepared for the consequences of a permanent scar and a lengthy recovery period, abdominoplasty may be just the answer for you.

LipoAbdominoplasty: Patient Categories

There are all kinds of different patients that present for a Tummy Tuck (TT) or Abdominoplasty. Time has taught us that Liposuction combined with the TT has improved results and decreased the patients re-operation rate. Now, almost all of our Aesthetic patients for TT’s undergo liposuction at the same time. These TT’s with Liposuction are referred to as LipoAbdominoplasty’s.

Looking back over our patient population it became evident that our LipoAbdominoplasty patients fell into several categories: Cosmetic, Massive Weight Loss (MWL), Girth, Staged, Un-Botched and Mommy Makeover (MMO) patients: Body Surgery Gallery.

The most common LipoAbdominoplasty patients we see are the Cosmetic or Aesthetic Patients. These LipoAbdominoplasty are often the cheapest, easiest surgery’s to perform and peri-operative risks are the lowest. These patients typically have Body Mass Index’s (BMI) below 27 to 30. The MWL patient is unique and is approached in a different fashion. Often large amounts of redundant skin in lower abdomen are removed. The posterior trunk or torso in the MWL patient may best be completed in a separate setting. The Girth patient can be one of the more complicated LipoAbdominoplasty patients and greater care must be taken with these patients. Their loss of domain and looseness of the abdominal musculature has to be corrected without causing respiratory compromise. For some patients the fat excess of the abdominal area (Lipodystrophy) is so severe that a Staged procedure can be required. In these patients liposuction of the superior abdomen is performed first. Then, many months later the Lipoabdominoplasty is completed. We have found staging with these patients has reduced post operative complications and improved results. Staged LipoAbdominoplasty patients are the most expensive LipoAbdominoplasty patients. Some patients who have already had surgery (i. e. Liposuction, TT, etc. ) by another practitioner and come to us for correction. These patients are typically very unhappy and feel that have been “Botched.” This category of LipoAbdominoplasty patient is referred to as the Un-Botched group. Medical records to include the patients previous operative report and pre-op photo’s are essential to review BEFORE any intervention. Sometimes more than one surgical procedure can be required to Un-Botch these patients. A MMO is where a LipoAbdominoplasty is combined with a patients desired Breast Surgery (i. e. Breast Augmentation/Lift /Reduction).

For most patients the goal with these types of surgery(s) is to obtain that pre-pregnancy appearance. The closer the surgeon could get to that appearance the more likely the patient would be satisfied. To make the issues less complicated I like to tell my patients “Women are hourglasses and men ice cream cones.”

Like many surgeons we utilize a Critical Pathway of Care with all our different groups of LipoAbdominoplasty patients in the peri-operative period. This methodology assist to reduce post operative adverse events or unfavorable outcomes and improve outcomes. To see different the types TT’s or LipoAbdominoplasty patients look here: Body Surgery Gallery.

Ultrasonically and Laser assisted Lipoplasty

Liposuction is a surgical procedure that can help sculpt the body by removing unwanted fat from specific areas, including the abdomen, hips, buttocks, thighs, knees, upper arms, chin, cheeks and neck. During the past decade, liposuction, which is also known as “lipoplasty” or “suction lipectomy,” has benefited from several new technological refinements. Today, a number of new techniques, including ultrasound assisted lipoplasty (UAL), the tumescent technique, laser assisted and irrigation techniques, are helping many plastic surgeons to provide selected patients with more precise results and quicker recovery times. Although no type of liposuction is a substitute for dieting and exercise, liposuction can remove stubborn areas of fat that don’t respond to traditional weight-loss and toning methods. Areas of excessive skin may have to be removed at the time of your procedure.

Ultrasound-assisted lipoplasty, commonly known as UAL, is a relatively new liposuction technique that uses sound waves to liquefy unwanted fat. Although it is not a substitute for traditional liposuction, UAL can be an effective tool for removing fat from fibrous body areas, such as the male breasts or the back, or for removing larger volumes of fat in a single procedure. Often, traditional liposuction is performed with UAL to help shape UAL-treated areas.

Laser Assisted Liposuction is a new liposuction technique. Lasers are utilized at the time of liposuction as an adjuvant to break up fat deposits, possibly heat skin to cause it to shrink and decrease surgeon fatigue when performing liposuction. Several different types of laser s are avliable to assist in liposuction. These are expensive devices and can add additional costs to your procedure. Consult with your plastic surgeon to determine which device would be best for you.

Liposuction can enhance your appearance and your self confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have UAL or liposuction of any type, think carefully about your expectations and discuss them with your surgeon. The best candidates for UAL are generally no different than candidates for the traditional liposuction procedure: normal-weight people with firm, elastic skin who have pockets of excess fat in particular areas. UAL candidates should be physically healthy, psychologically stable and realistic in their expectations.

As with traditional liposuction, serious medical complications from UAL are infrequent. One potential complication specifically related to the UAL technique is thermal skin injury or burn caused by the heat from the device. Also, temporary collections of fluid beneath the skin surface (seromas) are more common with UAL. Also, you should be aware that at present, the tube-like instruments or cannulas used to perform UAL are larger than the cannulas used for traditional liposuction. For this reason, some surgeons prefer to use the traditional liposuction technique in areas where an obvious scar may result. Cosmetic complications from all types of liposuction include: irregularities of the skin’s surface, areas of uneven pigmentation, and asymmetry. Some problems can be treated with additional surgery.

Body Sculpting for Men - Gynecomastia

Gynecomastia is a medical term that comes from the Greek words for “womenlike breasts.” It is actually quite common. Gynecomastia affects an estimated 40 to 60 percent of all men. It may affect only one breast or both. Certain drugs and medical problems have been linked with male breast overdevelopment, there is no known cause in the vast majority of cases.

For men who feel self-conscious about their appearance, male breast reduction surgery can help. The procedure removes fat and or glandular tissue from the breasts, and in extreme cases removes excess skin, resulting in a chest that is flatter, firmer, and better contoured. Various forms of Liposuction are often added to the procedure to assist in the overall result.

The best candidates for surgery have firm, elastic skin that will reshape to the body’s new contours. Surgery may be discouraged for obese men, or for overweight men who have not first attempted to correct the problem with exercise or weight loss. Also, individuals who drink alcohol beverages in excess and/or smoke marijuana are usually not considered good candidates for surgery. These drugs, along with anabolic steroids, may actually cause gynecomastia. Therefore, patients are first directed to stop the use of these drugs to see if the breast fullness will diminish before surgery is considered an option.

If excess glandular tissue is the primary cause of the breast enlargement, it will be excised, or cut out. The excision may be performed alone or in conjunction with liposuction.

If your gynecomastia consists primarily of excessive fatty tissue, your surgeon will likely use liposuction to remove the excess fat. In a typical procedure, an incision is made in an inconspicuous location–either on the edge of the areola or in the underarm area. Working through the incision, the surgeon cuts away the excess glandular tissue, fat and skin from around the areola and from the sides and bottom of the breast. Major reductions that involve the removal of a significant amount of tissue and skin may require larger incisions that result in more conspicuous scars. In extreme cases where large amounts of fat or glandular tissue have been removed, skin may not adjust well to the new smaller breast contour. In these cases, excess skin may have to be removed to allow the removing skin to firmly re-adjust to the new breast contour. The nipple may have to replaced back on the chest as a skin graft.

A small drain is usually inserted through a separate incision to draw off excess fluids. To help reduce swelling, you’ll probably be instructed to wear an elastic pressure garment. It may be three months or more before the final results of your surgery are apparent. Gynecomastia surgery can enhance your appearance and self-confidence, but it won’t necessarily change your looks to match your ideal. Before you decide to have surgery, think carefully about your expectations and discuss them frankly with your plastic surgeon.

Liposuction

Liposuction is a surgical procedure that can help sculpt the body by removing unwanted fat from specific areas, including the abdomen, hips, buttocks, thighs, knees, upper arms, chin, cheeks and neck. During the past decade, liposuction, which is also known as “lipoplasty” or “suction lipectomy,” has benefited from several new technological refinements. Today, a number of new techniques, including ultrasoundassisted lipoplasty (UAL), the tumescent technique, laser assisted and irrigation techniques, are helping many plastic surgeons to provide selected patients with more precise results and quicker recovery times. Although no type of liposuction is a substitute for dieting and exercise, liposuction can remove stubborn areas of fat that don’t respond to traditional weight-loss and toning methods. Areas of excessive skin may have to be removed at the time of your procedure.

To be a good candidate for liposuction, you must have realistic expectations about what these procedures can do for you. It’s important to understand that liposuction can enhance your appearance and self confidence, but it won’t necessarily change your looks to match your ideal or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your plastic surgeon. The best candidates for liposuction are normal-weight patients with firm, elastic skin who have pockets of excess fat in certain areas. You should be physically healthy, psychologically stable and realistic in your expectations. Your age is not a major consideration; however, older patients may have diminished skin elasticity and may not achieve the same results as a younger patient with tighter skin. Liposuction carries greater risk for individuals with medical problems suchas diabetes, significant heart or lung disease, poor blood circulation, or those who have recently had surgery near the area to be contoured.

In your initial consultation, your surgeon will access your health, determine where your fat deposits lie and assess the condition of your skin. Your surgeon will explain which of the various body-contouring methods that may be most appropriate for you. For example, if you believe you want liposuction in the abdominal area, you may learn that an abdominoplasty or “tummy tuck” may more effectively meet your goals especially if you have multiple pregnancies; or that a combination of traditional liposuction and UAL would be the best choice for you. Be frank and honest in discussing your expectations with your surgeon. He or she should be equally frank with you, describing the procedure in detail and explaining its risks and limitations. Individuals considering liposuction often feel a bit overwhelmed by the number of options and techniques being promoted today. However, this is where your plastic surgeon can help. In deciding which is the right treatment approach for you, your doctor will consider effectiveness, safety, cost and appropriateness for your needs. This is called surgical judgment, a skill that is developed through surgical training and experience. Your doctor also uses this judgement to prevent complications; to handle unexpected occurrences during surgery; and to treat complications when they occur.

For men, common sites for liposuction include under the chin and around the waist. Liposuction may also be used in the reduction of enlarged male breasts, a condition known as gynecomastia. Often in the female patient the best candidates for liposuction are of normal weight with localized areas of excess fat– for example, in the buttocks, hips, and thighs.

The time required to perform liposuction may vary considerably, depending on the size/location of the area, the amount of fat being removed, the type of anesthesia and the technique used. Liposuction is a procedure in which localized deposits of fat are removed to re-contour one or more areas of the body. Through a small incision, a narrow tube or cannula is inserted and used to vacuum the fat layer that lies deep beneath the skin. The cannula is pushed then pulled through the fat layer, breaking up the fat cells and suctioning them out. The suction action is provided by a vacuum pump or a large syringe, depending on the plastic surgeon’s preference. Sometimes ultrasound, laser or fluid is utilized to break up areas of the localized fat. Fluid is lost along with the fat, and it’s crucial that this fluid be replaced during the procedure to prevent shock. For this reason, patients need to be carefully monitored and receive intravenous ( IV ) fluids during and immediately after surgery. A snug compression garment worn immediately after surgery helps reduce swelling and bruising. Improvement will become apparent after surgery but it may take about six weeks, when most of the swelling has subsided to get a better idea of your result.

Fluid Injection, a technique in which a medicated solution is injected into fatty areas before the fat is removed, is commonly used by plastic surgeons today. The fluid — a mixture of intravenous salt solution, lidocaine (a local anesthetic) and epinephrine (a drug that contracts blood vessels) – helps the fat be removed more easily, reduces blood loss and provides anesthesia during and after surgery. Fluid injection also helps to reduce the amount of bruising occurring after surgery. The amount of fluid that is injected varies depending on the preference of the plastic surgeon. Large volumes of fluid — sometimes as much as three times the amount of fat to be removed — are injected in the tumescent technique. Tumescent liposuction performed only with local anesthesia usually takes significantly longer than traditional liposuction (sometimes as long as 4 to 5 hours). The super-wet technique is similar to the tumescent technique, except that lesser amounts of fluid are used. Usually the amount of fluid injected is equal to the amount of fat to be removed. This technique often requires IV sedation or general anesthesia and typically takes one to two hours of surgery time. Ultrasound Assisted Lipoplasty (UAL). This technique requires the use of a special cannula that produces ultrasonic energy at the tip. As it passes through the areas of dense fat, the energy explodes the walls of a more proportional removal of fat. Laser assisted liposuction functions in a similar fashion as UAl. The laser assist to rupture fat cells allowing for the easy removal of the fat deposits, usually with less bruising. The fat is then removed with the traditional liposuction technique. UAL and Laser Liposuction have been shown to improve the ease and effectiveness of liposuction in fibrous areas of the body, such as the upper back or the enlarged male breast. They are also commonly used in secondary procedures, when enhanced precision is needed. In general, UAL and Laser Liposuction take longer to perform than traditional liposuction.

Liposuction is normally safe, as long as patients are carefully selected, the operating facility is properly equipped and the physician is adequately trained. Your surgeon must have advanced surgical skills to perform procedures that involve the removal of a large amount of fat (more than 5 liters or 5,000 ccʼs). Also, more extensive liposuction procedures require attentive after-care.

Imperfections in the final appearance are not uncommon after lipoplasty. The skin surface may be irregular, asymmetric or even “baggy,” especially in the older patient. Numbness and pigmentation changes may occur. Sometimes, additional surgery may be recommended to remove excessive skin or fat.

After surgery, you will likely experience some fluid drainage from the incisions. Occasionally, a small drainage tube may be inserted beneath the skin for a couple of days to prevent fluid build-up called a seroma. To control swelling and to help your skin better fit its new contours, you may be fitted with a snug garment to wear over the treated area for a few weeks to a month. Healing is a gradual process. Your plastic surgeon will probably tell you to start walking around as soon as possible to reduce swelling and to help prevent blood clots from forming in your legs. You will begin to feel better after about a week or two and you should be back at work within a few days following your surgery. Activity that is more strenuous should be avoided for about a month as your body continues to heal. Although most of the bruising and swelling usually disappears within three weeks, some swelling may remain for six months or more.

You will see a noticeable difference in the shape or contour of your body quite soon after surgery. However, improvement will become even more apparent after about four to six weeks, when most of the swelling has subsided. After about three months, any persistent mild swelling usually disappears and the final contour will be visible.

Mommy Makeover

A Mommy Makeover refers to Aesthetic Breast & Abdominal Surgery on the post-pregnancy female. The Surgery is commonly directed at concerns patients have about their breasts or tummies which have occurred following having children. Issues of involuted and / or sagging breasts, excessive or lax abdominal skin and the appearance of still appearing pregnant many months following delivery are addressed. These surgery’s are typically performed in one surgical session. Thus, the laypersons terminology of a “Mommy Makeover.”

Cosmetic Surgical procedures of the Breast and Abdomen done in combination that are considered part of the Mommy Makeover have included:
– Breast: Augmentation, Mastopexy or Lift, Reduction, etc.
– Abdomen: Abdominoplasty (TT), Mini Abdominoplasty, Liposuction, etc.
Mommy Makeovers are not minor procedures and can require a longer recovery period. Each patients makeover is designed individually for the Mommy’s concerns. A link to Mommy Makeovers performed by Dr. Culbertson can be found here: Mommy Makeover Gallery.

Plastic Surgery After Dramatic Weight Loss

Patients that undergo weight loss surgery are often referred to as bariatric Patients. The net result following these types of surgery is usually Massive Weight Loss (MWL). Plastic Surgery After Dramatic Weight Loss in the post-bariatric or MWL patient has become a very common set of surgical procedures in Plastic Surgery. Consider focusing in on the area of your body that you are most concerned and address that first. For many MWL patients the 1st area of major concern is the abdominal region. Removal of the excessive skin with liposuction and tightening of the abdominal wall is referred to as a LipoAbdominoplasty. The technique can focus on the abdomen or involve the entire lower body. When the entire lower body is addressed in one surgical setting it is referred to as a Lower Body Lift. Many patients prefer to separate surgical treatment of the lower body with a Tummy Tuck, Lateral Thigh Lift, and/or Buttocks Lift / Buttocks Lift with Augmentation. If the abdomen or lower body is your primary concern let Dr. Culbertson know & he will work out which surgical procedure(s) would best address your concerns.

The second most common area addressed in the MWL patient are the arms. Correction of excessive and redundant skin & fat in the arm & chest flank regions is referred to as a Brachioplasty. There are different types of Brachioplasty’s depending upon the severity of the condition following the patients weight loss.

Other areas that MWL patients address are the breasts, buttocks, face & thighs. Let Dr. Culbertson know your major concerns & he will provide you with surgical alternatives to address your issues.