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What’s the Difference Between Panniculectomy & Abdominoplasty?

It’s not unusual for massive weight loss patients to develop loose, saggy abdominal skin. This excess skin can cause a variety of functional problems including chronic rashes, infection, and back pain. In addition, loose abdominal skin may cause aesthetic deformities which effect self-esteem and self-image.

For these reasons, patients frequently seek corrective surgery following massive weight loss. When this situation arises, a variety of treatment options exist that address the skin, fat, and underlying muscles. These procedures are tailored to the patient’s specific anatomic findings and unique aesthetic goals. 
Omaha Plastic Cosmetic Surgeons

In some cases, an abdominal panniculectomy can be performed. This procedure involves removal of excess lower abdominal skin. When this skin apron is removed, the umbilicus and underlying muscles are left alone. This procedure has a significant impact on function, but has aesthetic limitations. These include continued upper abdominal loose skin, pubic skin sag, and weak abdominal muscles. 

For these reasons, it’s not unusual for patients to request abdominoplasty surgery. This procedure not only removes excess lower abdominal skin, but also removes excess upper abdominal skin and tightens the abdominal muscles as well. This procedure requires detachment of the umbilicus and transposition to a higher level. It’s associated with improved functional results and dramatically improved abdominal aesthetics. Unfortunately, tightening the abdominal muscles does occasionally prolong the recovery period. 

It’s important to realize that each patient’s situation is unique. For this reason, it’s important to discuss your aesthetic goals with your plastic surgeon. Your plastic surgeon should be able to formulate a treatment plan that’s appropriate for your aesthetic goals and life style. In your case, it may not be appropriate to tighten your abdominal muscles. 

What are ‘Dog Ears’?

Dog ears are abnormal bulges of tissue that typically occur along the ends of surgical incisions. This problem occurs for a variety of reasons, including discrepancies in length of the opposing wound borders and wound closures around curved contours. 
Omaha Cosmetic Plastic Surgery

Dog ears can occasionally be seen following abdominal wall panniculectomy. When this occurs, secondary surgery may be necessary. In most cases, this involves a simple excision of the dog ear under local anesthesia. In other cases where the dog ear is large and extends posteriorly towards the back, correction may require extension of the incisions in a posterior direction. In some cases, where an abnormal roll of tissue is present the incision may extend to the midline of the back. 

Although every effort is made to avoid dog ears during the primary surgical procedure, this complication is occasionally unavoidable. When this situation arises it’s important to discuss your options with your plastic surgeon. Your surgeon should be able to formulate a treatment plan that addresses your concerns. 

The Difference Between a Plastic Surgeon and a Cosmetic Surgeon

The term “plastic surgeon” and “cosmetic surgeon” are frequent sources of confusion amongst plastic surgery patients. These terms are often used interchangeably, but actually have significant differences in their meanings.

Plastic surgeons have undergone residency training in plastic surgery. This involves upwards of 7 to 8 years of training in this area of endeavor. The vast majority have undergone testing to obtain board certification in this specialty as well. 

Cosmetic surgeons are individuals who perform cosmetic surgery. This may include plastic surgeons along with a large number of physicians from varied specialties including dermatology, otolaryngology, ophthalmology, oral surgery, and gynecology. In our community, we even have family physicians and emergency room physicians who now call themselves cosmetic surgeons. In this situation, these physicians don’t even have basic surgery training, let alone specialty surgery training.

The bar is relatively high for a physician to use the term plastic surgeon. In contrast, anyone who performs or wants to perform cosmetic surgery can call themselves a cosmetic surgeon. Unfortunately, there are many practitioners with minimal training and experience performing these procedures with very little regulation. It’s not uncommon to see aggressive advertisements that make claims that just can’t be substantiated. In this environment it’s truly buyer beware and for this reason board certification is extremely important.

Even the issue of board certification can be confusing because not all boards are created equal. It’s important that the board be certified by the American Board of Medical Specialist. This organization ensures that the board is reputable. These boards require residency training, testing, and certification. 

It’s important that your surgeon be board certified by a specialty that’s dedicated to cosmetic surgery. Although the vast majority of “cosmetic surgeons” are board certified, in many cases these boards don’t traditionally have anything to do with aesthetic surgery.

Many factors should be considered when choosing a surgeon. These include training, experience, reputation, and certification to name a few. The selection of your surgeon is the most important decision you will make when considering aesthetic surgery, so make it carefully. 

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Acrylic Nails & Fingernail Polish

When cosmetic surgery is performed, safety should always be the number one priority. For this reason, pulse oximetry is used to monitor oxygen levels throughout the surgical experience. This process is started in the pre-operative holding area and is continued throughout surgery and recovery.

Pulse oximetry involves placing a device on the finger which measures oxygen levels through the finger nails. It’s not unusual for patients to present for surgery wearing acrylic nails and finger nail polish. Finger nail polish can interfere with pulse oximetry and for this reason should be removed prior to surgery. In the vast majority of cases, acrylic nails don’t represent a problem when pulse oximetry is utilized. If you have questions regarding this topic, make sure they’re answered during your pre-operative consultation.

Preoperative Testing

When patients undergo cosmetic surgery, safety should always be a priority. The pre-operative evaluation varies from patient to patient and depends on a variety of factors. 

The starting point is a comprehensive history and physical examination. Depending on the findings of this evaluation additional studies and consultation may be necessary before proceeding with surgery.

We generally recommend a mammogram on any patient over forty years of age. An EKG is performed on anyone older than fifty. Laboratory studies are performed on an individual basis and depend upon the medical evaluation. The vast majority of patients have CBC’s and pregnancy tests. 

In many cases, consultation with cardiology, pulmonology, and endocrinology are appropriate based on the patient’s medical history.

It’s important to remember that cosmetic procedures are major surgical procedures that have associated risks. For this reason, safety should be everyone’s first priority.

Ultrasonic Liposuction

A large number of liposuction techniques are currently available for treating localized areas of fat. These techniques have specific indications and are often associated with unique advantages and disadvantages.


Ultrasonic liposuction which is also known as ultrasonic assisted liposuction utilizes high energy sound waves to destroy fat cells. This process is known as cavitation and results in the formation of an oily material which is then removed by standard liposuction techniques.

In the vast majority of situations, ultrasonic liposuction offers no significant advantages over tumescent liposuction. However, when fat deposits are associated with fibrous tissue ultrasonic liposuction may offer unique advantages. This technique is therefore often utilized in the flanks and chest of men. 

If you’re considering ultrasonic liposuction, it’s important to consult a board-certified plastic surgeon. This surgeon should be able to formulate an appropriate treatment plan for your condition.