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Changing the body’s appearance is often times more involved than just eating a well balanced diet and exercising regularly.  Even the strictest of diet and exercise regimens are sometimes not enough to eliminate fatty tissues stored in the body.  We offer many different safe, effective procedures that will assist you in achieving the body of your dreams.  Talk to the doctor during your initial consultation about your body contouring options.

 

Tummy Tuck

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Sometimes simply dieting and exercising are not enough to take care of waistline problems.  In such cases, a patient may wish to consider a tummy tuck (or abdominoplasty).  A tummy tuck is the surgical removal of excess skin or fatty deposits from the abdomen, along with the repositioning of abdomen muscles into a tighter formation.  This bodily enhancement procedure is designed for those who wish to have a flatter and tighter stomach.  It is also helpful in remedying the vertical separation of abdomen muscles known as diastasis, which can occur following pregnancy.

Reasons for Considering an Abdominoplasty:

  • Inability of dieting and exercise to improve the abdomen area.

  • Excessive accumulation of skin following weight loss.

  • Loss of skin elasticity or diastases (loose abdomen muscles) due to pregnancy.

  • The removal of unsightly skin and fat deposits as well as the proper alignment of the abdomen muscles to produce a more flattering look.

Q & A

What is a “Tummy Tuck”? Abdominoplasty, or “Tummy Tucks” are operations designed to improve the contour of the lower abdomen. Bulges in the lower abdomen consist of three components:

1. Fat: Fat deposits in the lower abdomen can be very resistant to weight loss and exercise. Typically, the stubborn fat is located below the umbilicus and the flanks in a “spare tire” pattern. 

2. Skin: The skin of the lower abdomen can be stretched considerably by weight loss or pregnancy. Stretch marks are a sure sign that excess skin is present. 

3. The abdominal wall: Muscle and tendinous structures composing the abdominal wall can also be stretched out. This can be seen in people with very little fat who still have a bulge in the lower abdominal wall. Abdominoplasty is designed to correct all three components with one operation.

Sounds extreme! Why not just do liposuction? Liposuction is an excellent method of removing fat deposits that are resistant to weight loss. However, if there is excess skin that has been stretched out by childbearing or weight gain, the skin will not “snap back” after liposuction is done. Instead, the extra skin will hang loosely as a “pannus” or “dewlap” from the lower abdomen after the fat is removed. Skin does not shrink to fit new volume like the rubber on a balloon after the air is let out. Any one who has gained significant weight or had children will tell you that stretched-out skin does not go away.

What about the scar? Removing excess skin necessarily leaves a scar. Just as a face-lift removes excess facial skin and leaves a scar on the face, abdominoplasty will leave a scar on the abdomen. Choosing to have an Abdominoplasty is a conscious choice to improve your body shape at the cost of a rather large scar. The good news is that the scar is normally hidden by your underwear, except for a scar around the umbilicus. Scars vary quite a bit from individual to individual, but they are normally well-accepted in view of the improved body shape.

How is the operation done? First, an incision is made across the entire lower abdomen within the “bikini line”. It is then taken deeper down to the abdominal wall. Next and incision is made around the umbilicus to detach it from the surrounding skin. Working through the lower abdominal incision, the fat is lifted off of the underlying abdominal wall from the pubic area to just below the ribs. The skin and fat of the lower abdomen from the umbilicus down is then removed by cutting across it. Excess fat under the upper abdominal skin is then removed. Sutures are placed in the abdominal wall to tighten it - a process called “plication”. The upper abdominal skin is then stretched down to close the open wound. A new hole for the umbilicus is made in the midline of the abdomen and the umbilicus is sewn in place. Drains are placed to prevent fluid accumulation from “weeping” of the tissues.

What about “Mini” Tummy Tucks? “Mini” Abdominoplasties are a limited version of a full Abdominoplasty. In this operation, skin and fat are lifted only off of the abdominal wall below the umbilicus. The bulging abdominal wall is then tightened with sutures, and only a small amount of skin is removed. Liposuction can be safely performed on the abdomen with this procedure at the same time due to the more limited extent of the operation. Since less skin is removed, the scar is smaller. The problem with this operation is that there are very few appropriate candidates. If you have slightly loose skin overhanging the umbilicus, this operation will not correct it. Similarly, very few women have an abdominal bulge that is mostly due to the abdominal wall below the umbilicus. Typically, most patients seeking consultation for an Abdominoplasty have significant excess skin and fat both below, and above the umbilicus.

What other operations can be done at the same time? Other procedures are commonly done in properly selected patients. These can range from breast surgery (breast augmentation or reduction), to face-lifts. Liposuction in areas outside the abdomen such as the thighs can also be safely performed. However, liposuction of areas adjacent to the abdomen requires caution, as they can lead to complications and poor wound healing of the incisions. Adding additional procedures also prolongs the time under anesthesia and may require hospitalization to insure safety. Prolonging anesthesia times can significantly add to the risk of the procedure.

When will I know what the final result will be? Usually the scars take three months to six months to remodel and mature. “What you see is not what you get” until this period of time has elapsed. The shape and minor irregularities “settle out” with time and things continue to improve up to six months after the surgery. The result typically looks good about 30 days after the operation, but continues to “evolve” afterwards.

What if I have scars on my abdomen from previous surgery? If the scars are below the umbilicus, they can be totally removed with the excess skin on the lower abdomen. Scars above the umbilicus in the midline of the abdomen will need to be revised (removed and re-closed) since they will not stretch with the abdominal skin used to close the wound created when the excess skin is removed from the lower abdomen. Revising a midline scar can also enhance the result by allowing removal of additional excess skin adjacent to the midline in conjunction with skin of the lower abdomen. Scars from older gallbladder operations in the right upper abdomen can cause special problems or concerns that your surgeon will discuss with you.

Does it hurt? Yes, Abdominoplasty is a large operation that can be compared to a ceasarian section. It is commonly done as a “same day” surgery with patients being discharged immediately after recovery from the anesthetic, but this can lead to a rough first night at home. Overnight hospitalization is recommended for those patients who can afford it, to assist with pain control. Ideally, patients would stay overnight with an epidural catheter in place. This removes almost all pain during the worst part of the post-operative period. As with most operations, pain is most intense during the first 12 to 24 hours after surgery.

Who is a good candidate for an Abdominoplasty? Good candidates are patients with a low risk for anesthesia who have excess fat and skin in the lower abdomen. Stretch marks are usually a sure sign that Abdominoplasty is the best option to correct the problem.

How much time will I need to take off work? Usually, two weeks are needed to return to work comfortably. Highly motivated patients can return to work sooner with safety provided their work duties are not physically strenuous. Typically, these large operations also leave patients with a lack of energy and easy fatigue. A common complaint is feeling as though “all the energy has been sucked out of me”. This lasts for at least two weeks after the operation.

What activity restrictions will I have? Activity limitations are similar to those for any major abdominal surgery. Lifting greater than 10 to 15 pounds is not advisable due to placation of the abdominal wall. Aerobic exercise such as running is not advisable until three or four weeks after surgery. Weight lifting should be avoided for six weeks, and then resumed slowly with less weight than that lifted pre-operatively.

Will my insurance plan cover the costs of the cosmetic procedure? Unfortunately, the answer is clearly no. In fact, most insurance companies require that you sign a statement of understanding that you are responsible for the costs of the non-covered procedure. Payment for the costs of cosmetic surgery is due in advance for the hospital, the surgeon, and anesthesia.

Is financing available for cosmetic surgery? Yes! Aesthetic Surgery Associates is able to help you apply for financing with finance companies that specialize in funding cosmetic procedures.

Can I have a Tummy Tuck at the same time as a Gynecologic operation such as a hysterectomy, tubal ligation, or laparoscopy? Fortunately, the answer is yes. In the past, there were concerns about the potential increased risk for infectious complications from the combined procedures. A number of scientific studies not validate the safety of doing some cosmetic procedures at the same time as you Gynecological procedures.

Why would I want to combine these types of operations? The answer consists of two parts: 1. Cost savings 2. Combined recovery times. Cost savings are realized by having insurance plans cover the initial start of the operation in the operating room, the initial anesthesia, and your hospital room. Of course, this depends on whether or not the gynecologic operation is covered by your insurance. Adding a cosmetic procedure to one covered by insurance allows lower charges for the total cosmetic procedure “package”. If you are having gynecologic surgery for medically indicated reasons, there is usually a recovery time involved that includes time off of work. By having your cosmetic operation at the same time as you gynecologic procedure, you can recover from both at the same time!


Additional information can be found on the following web sites:
plasticsurgery.org
surgery.org

To arrange a consultation, please call Aesthetic Surgery Associates at (254) 526-5106 or toll-free 1-866-232-0469

 

Mommy Makeover

 

 

Mini Tummy Tuck

 

“Mini” Abdominoplasties are a limited version of a full Abdominoplasty. In this operation, skin and fat are lifted only off of the abdominal wall below the umbilicus. The bulging abdominal wall is then tightened with sutures, and only a small amount of skin is removed. Liposuction can be safely performed on the abdomen with this procedure at the same time due to the more limited extent of the operation. Since less skin is removed, the scar is smaller. The problem with this operation is that there are very few appropriate candidates. If you have slightly loose skin overhanging the umbilicus, this operation will not correct it. Similarly, very few women have an abdominal bulge that is mostly due to the abdominal wall below the umbilicus. Typically, most patients seeking consultation for an Abdominoplasty have significant excess skin and fat both below, and above the umbilicus. 

To arrange a consultation, please call Aesthetic Surgery Associates at (254) 526-5106 or toll-free 1-866-232-0469

 

Belt Lipectomy

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A body lift, also known as a belt lipectomy, is a procedure to raise and reshape unsightly, sagging body contours.  During the aging process, skin loses some elasticity, causing the mid-section to lose its natural shape and firmness.  This procedure is designed to remove loose skin and related fat deposits, thus, providing a more youthful appearance.  A body lift can be applied to the lower torso and upper legs including the abdomen, waist, inner/outer thighs, buttocks, and/or hips. Liposuction may also be completed in conjunction with a body lift.

Reasons for Considering a Body Lift:

  • Reshape mid-body contour.

  • Correct sagging skin and fat due to aging or excessive weight loss.

  • Remedy weight gain and stretched skin caused by multiple pregnancies.

General Procedure

The precise procedure varies with each patient, depending on the body type and desired surgical outcome.  Generally speaking, the body lift procedure entails making an incision that follows the upper and/or inner thigh, to the waistline.  In more extensive surgeries, the incision goes completely around the waist and lower back.  Adjustments to the buttocks and thighs require an incision at the crease of the buttocks.  Excess skin is then removed, followed by the underlying fat deposits.  Finally, the skin is pulled taught and sutured into the new configuration.  The entire procedure can last from 3 to 7 hours.  The surgery is performed under general anesthesia.

Recovery Process

Generally, post-operative instructions require plenty of rest and limited movement in order to speed up the healing process and recovery time.  Bandages are applied right after surgery to minimize swelling and provide support.  Tubes are often placed to drain excess fluids.  The scars resulting from the incisions are permanent but are carefully placed so as to minimize visibility.  Patients sometimes report minor pain associated with surgery which can be treated with oral medication.  Recovery time varies with the extent of the procedure.  While complications are rare, patients can minimize potential problems by carefully following the directions that are given after the surgery.

 

Liposuction

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Liposuction is a body-sculpting procedure to remove fat that is unresponsive to dieting and exercising.  This procedure can be applied to nearly any area of the body and is commonly used on multiple areas during an operation.  Liposuction results in a slimmer and better proportioned figure.  Liposuction is used effectively to reduce love handles, saddlebags, a double-chin, a bulge around the waistline, or other unsightly fatty deposits in order to develop a better shape and create a more beautiful body.

Reasons for Considering Liposuction:

  • Eliminate fat from any of the following areas:

    • Chin and Neckline

    • Back

    • Upper Arms

    • Stomach and Waistline

    • Hips and Buttocks

    • Thighs and Knees

    • Calves and Ankles

  • Create a more proportioned figure

Liposuction is not a replacement for proper exercise and diet.  Instead, liposuction is a reduction procedure for stubborn areas where fat accumulates.  Used in combination with several areas of the body, liposuction can provide a well proportioned body appearance.  Ideal surgical candidates are those already in good physical condition but having stubborn areas that do not respond to diet and exercise.

Q & A

Can liposuction help me lose weight? Liposuction is not recommended as a substitute for weight loss. It is designed to improve the shape or contour of the body in patients who have (ideally) had stable weight for at least a year. Expecting liposuction to compensate for a bad diet and lack of exercise is unrealistic. In a small sub-set of patients who have well-defined areas of fat deposition that do not respond well to weight loss, liposuction can help as a “head-start” by creating greater optimism for achieving a desirable shape after further weight loss. It serves as a “motivator” in this setting, but is still not a substitute for diet an exercise.

What makes someone a good candidate for liposuction? Patients who have a stable baseline weight over a year’s time, and who have fatty bulges in specific areas that stubbornly resist weight loss are the best candidates. Typically, these are individuals who complain of “saddle bags”, or “love handles” that remain despite their being satisfied with their overall body mass and contour. Liposuction works best as a means to refine a good underlying shape or contour in patients who have a stable weight.

What makes someone a bad candidate for liposuction? Individuals seeking liposuction as a means to continue dietary misbehavior, or as a substitute for weight loss by diet and exercise are marginal or poor candidates. Liposuction can be done on these patients, and it can temporarily improve things. In the long run, however, weight is regained and the procedure ultimately makes little difference in overall appearance or self-esteem. Similarly, patients with stretched skin (such as the tummy) frequently request liposuction. If stretching has occurred due to weight gain or pregnancy, liposuction will create even more loosely hanging skin after removal of the supporting fat. Many patients seeking consultation for liposuction of the abdomen actually need an Abdominoplasty. If loose skin is present, liposuction can make the appearance worse!

Can fat come back after liposuction? A short answer to this question is “yes, but the bulges that occur with weight gain arise in areas other than the one that has undergone liposuction. The theory behind liposuction is that we all have a fixed number of fat cells after adolescence. Weight gain occurs as fat cells fill up with stored fat and become physically larger (thus bulges or “paunchiness”). Patients who are morbidly obese (100% above ideal body weight) have fat cells that divide, thus increasing their total number. This is in response to the existing fat cells being too full to store more fat. Liposuction removes the fat cells, thus preventing fat from being stored in these areas with future weight gain. If a patient continues to consume too many calories after having undergone liposuction, fat will be stored in the remaining fat cells outside the area that was operated on. The result is that fatty tissue in other parts of the body will increase in size more significantly than in the liposuctioned area.

Will liposuction improve cellulite? There are many surgeons who feel that liposuction will improve cellulite, and advertise this fact heavily. “Superficial” liposuction was marketed as a specific technique that targets cellulite. Suffice it to say that these “innovations” have proven to be a triumph of marketing rather than results. Cellulite is more that a problem of lumpy fat deposition. Any one who has cellulite can show you that the irregularity disappears if tension is placed on the skin. This is because cellulite is caused by a combination of skin laxity and fat compartmentalization. With age and sun damage, the skin becomes loose and bulges outward from the force of focal fat collections under it. Removing the fat will not take care of the skin laxity problem. In fact, lax skin will tend to look much worse after liposuction since it has a tendency to hang loosely after the supporting fat is removed. In the face of pervasive marketing pressures from surgeons, it is important that assurances from you prospective surgeon pass a test of “common sense” and, above all, honesty.

What happens is I gain weight after liposuction? Will the bulges come back in the same area? As mentioned above, the fat will accumulate in the remaining fat cells regardless of where they are located. Typically, significant weight gain will create bulges in other areas than the one that was liposuctioned. The “take-home point” here is that all fat cells store fat, and bulges are related to the density of the cells in a particular area. The more cells that are available to store fat at a given location, the more likely that area will expand with weight gain when compared with areas having fewer cells.

How is liposuction done? Small incisions are made in the skin to gain access to the fatty areas. These incisions are usually about ½ inch long or less. Specially designed hollow metal tubes are inserted through these incisions and passed through the subcutaneous tissues to reach the area of excessive fatty deposition. Typically, the incisions (ports) are placed to allow approaching the fatty area from more than one angle to help assure a more even removal of the fat. The ports can be placed at a significant distance from the fatty area to insure they are hidden in natural skin creases or areas that are covered with clothing. High suction is placed on the hollow tube, and fat cells are suctioned out of the area by passing the tube back-and-forth many times.

What are the risks of liposuction? As with any surgery, there is the potential for bleeding and infection. If bleeding causes significant bruising, the pigment from the blood can stain the skin permanently. This is a rare problem and is called “hemosiderin staining”. The biggest source of complaints after liposuction is unevenness of the result, or asymmetry of one side of the body when compared to the other. Usually, the differences are minimal, but they may require additional surgery to correct. Areas of significant depressions can be caused by over-aggressive removal of fat, and these can be very challenging to correct. Scars are seldom a source of dissatisfaction for patients, since they are small and typically well hidden. The scars resulting from Ultrasonic liposuction tend to be slightly larger and more conspicuous, but rarely need revision if they are allowed sufficient time to remodel and settle. Fluid collections termed seromas can occur as straw-colored fluid weeps into the cavity formed after fat is removed. These may need to be aspirated multiple times in the clinic with a needle before they resolve completely.

What is tumescent liposuction? In the past, patients were encouraged to donate their own blood for transfusion (autologous blood donation) prior to undergoing liposuction, due to the amount of blood loss associated with the procedure. Tumescent liposuction was developed as a means to decrease blood loss, and reduce pain experienced during the surgery. The technique involves injecting large amounts of solution containing dilute local anesthetic (similar to that used by a dentist when anesthetizing a tooth), and a potent vaso-constrictive medication called epinephrine (also known as adrenaline). The epinephrine causes blood vessels in the skin and fat to contract, thus decreasing the tendency for bleeding. The technique has been proven to be safe and effective. Significant blood loss is very rare since tumescent liposuction has become widely employed. Decreased blood loss has also decreased bruising from the procedure and improved post-operative recovery.

Is Ultrasonic liposuction better than more traditional techniques? Ultrasonic liposucton has been available for many years, but has not become the dominant means of fat removal that was initially envisioned. This technique passes a special rod into the tissue that vibrates at ultrasonic frequencies (typically 20kHZ or greater) and emulsifies the fatty tissue. Traditional liposuction is then done to remove the debris and emulsified fat. In fibrous tissue that binds the fat or makes it difficult to remove, ultrasonic emulsification helps increase the volume that can be resected. It is especially useful in male breasts and in fatty deposits on the flank. Typically, ultrasound is now used for secondary (re-do) liposuction or for treating areas that are resistant to standard liposuction. It requires significantly more operating time to perform, and can increase the potential for complications such as fluid collections or prolonged swelling.

What is large-volume liposuction? The American Society of Plastic Surgeons defines large-volume liposuction as removal of more than 5 liters of fat during a procedure. Establishing this standard was in response to greater and greater volumes of fat being removed in an out-patient setting. Large-volume procedures involve a bigger stress-reaction to surgery and larger changes in the distribution of fluid in the body. It is recommended that patients undergoing large-volume procedures undergo overnight observation in the hospital following their operation. The distinction is one of volume removal alone, and is not related to how the procedure is performed.

Will I have to wear a compression garment afterwards? Compression garments are almost universally recommended during the post-operative recovery. When compression is begun after surgery is highly variable between different surgeons. Some put the garment on their patients in the operating room, while others wait a day or more until the initial swelling has improved. Most surgeons recommend continuing compression for a month after the procedure. This can depend on the area liposuctioned, and the extent of the procedure.

Can I have Liposuction at the same time as a Gynecologic operation such as a tubal ligation or laparoscopy? For operations that do not involve body areas that would predispose to infection, liposuction can be done safely. Operations such as tubal ligation or laparoscopy are good examples.

Why would I want to combine these types of operations? The answer consists of two parts: 1. Cost savings 2. Combined recovery times. Cost savings are realized by having insurance plans cover the initial start of the operation in the operating room, the initial anesthesia, and your hospital room. Of course, this depends on whether or not the gynecologic operation is covered by your insurance. Adding a cosmetic procedure to one covered by insurance allows lower charges for the total cosmetic procedure “package”. If you are having gynecologic surgery for medically indicated reasons, there is usually a recovery time involved that includes time off of work. By having your cosmetic operation at the same time as you gynecologic procedure, you can recover from both at the same time!

Additional information can be found on the following web sites:
plasticsurgery.org
surgery.org

To arrange a consultation, please call Aesthetic Surgery Associates at (254) 526-5106 or toll-free 1-866-232-0469

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254.526.5106
800 West Central TX Expressway 
Suite 100, Harker Heights, TX 76548

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