Pre-Operative Blood Testing

The vast majority of patients who are undergoing cosmetic surgery have preoperative blood testing which includes a CBC. This test has several components which are critical elements of the preoperative evaluation. These include the platelet count, the white blood cell count, and the hematocrit and hemoglobin levels. Each of these measurements is extremely important. The platelet count measures the patient’s ability to clot blood, an elevated white blood cell count is an indicator of infection, while the red blood cell count, hematocrit, and hemoglobin all measure the body’s oxygen carrying capacity.
 
Occasionally other blood tests are performed in combination with a CBC based on your physical findings.

If you’re concerned about your preoperative blood testing, it’s appropriate to consult your plastic surgeon. Your surgeon should be able to discuss these lab values in detail.

Pregnancy Following Tummy Tuck Surgery

The vast majority of women who undergo tummy tuck surgery are done having children.  Rarely, women who have undergone abdominoplasty change their minds about additional pregnancies or accidentally become pregnant. Under these circumstances, tummy tuck has no negative impact upon the pregnancy.  Unfortunately, pregnancy has a negative impact upon the patient’s previous abdminoplasty.  Pregnancy recreates many of the patient’s original problems, including loose saggy skin, weakened abdominal muscles, and stretch marks.

Because of the significant investment in time, money, and effort, we strongly recommend that patients be done having children before proceeding with abdominoplasty.  Even when women don’t plan on having additional children, their life circumstances change and they become pregnant.  Under these circumstances, revision of the original tummy tuck can be undertaken with success.

How to Get Rid of Flabby Arms

Flabby upper arm tissue can represent a significant aesthetic deformity that can adversely impact self-esteem and self-image. When this situation arises, several treatment options exist which can improve upper arm aesthetics. These include liposuction, mini brachioplasty and full brachioplasty. The procedure chosen is dependent upon the patient’s aesthetic goals and specific anatomic findings.  

In some cases, liposuction may be a viable alternative. When this procedure is utilized, scarring is minimal and results are usually excellent. Unfortunately, this procedure is only effective when fat is present and skin is relatively tight.

When excess skin is confined to the upper arm in the area of the axilla, a mini brachioplasty may be effective. This procedure utilizes an incision in the upper arm which is transversely oriented and well hidden. The procedure is helpful when patients have minimal excess upper arm skin and is associated with excellent results. 

Unfortunately, the vast majority of patients who have had significant weight loss require more extensive procedures. In most cases, this involves a full brachioplasty with an incision that extends from elbow to axilla. This procedure addresses excess skin in the vertical and transverse dimensions. In most cases, results are excellent, but occasionally adverse scarring can be a problem.  

When significant excess skin is present laser tightening and other non- surgical treatments aren’t effective. For this reason, patients who have significant arm skin sag should consult a board certified plastic surgeon who can formulate an appropriate treatment plan.

Will Skin Be Tightened After Liposuction?

Skin tightening following liposuction varies from patient to patient and depends on a variety of factors. It’s not unusual to have skin tightening following liposuction in patients who are younger and have good skin tone. In older patients with poor skin tone, liposuction might result in skin sag because of poor skin contraction.

Skin tightening isn't unique to post-operative liposuction patients, but also occurs following massive weight loss and pregnancy. How individual patients respond to these changes is dependent upon their genetics and biologic behavior. Although multiple liposuction techniques are available that reportedly tighten skin, the patients wound healing biology and genetics are the most important variables.

If you’re considering liposuction and are concerned about skin sag, it’s important to consult a board certified plastic surgeon with experience in this area. This surgeon should be able to assess your risk for skin sag.

Weight Loss Before Liposuction

Whenever possible, patients should be near their ideal body weight before they undergo liposuction. For some patients this just isn’t possible and under these circumstances a stable body weight is acceptable. When patients are actively losing weight, it’s appropriate to delay surgery until a stable weight has been obtained.

It’s important to realize that weight fluctuations after surgery can adversely impact the results of liposuction. For this reason, every effort should be made to reach a stable weight that can be easily maintained before and after surgery.

Massage After Liposuction

There are no scientific studies that conclusively demonstrate that massage is helpful following liposuction. Despite this, many plastic surgeons utilize massage as a routine component of postoperative care following this procedure. They believe that massage minimizes internal scarring, decreases edema, and helps remodel soft tissue.

It’s not unusual for patients to complain of swelling, tightness, and stiffness following this procedure. Massage and an early return to physical activity seems to help with these issues. For these reasons, plastic surgeons often recommend gentle massage and stretching exercises after liposuction. These are usually started 7 to 10 days following the procedure. Initially these maneuvers cause mild discomfort which quickly resolves with time.

If you’re planning liposuction, it’s important to discuss this issue with your plastic surgeon. In many cases, massage will be an important part of your postoperative care.

General or Local Anesthesia for Liposuction?

Tumescent liposuction represents a significant advance in the management of localized fat collections.  When this techniques is utilized with local anesthesia alone the response varies from patient to patient. The majority of patients appear to do well and have good results especially when smaller amounts of fat are removed. Unfortunately, we frequently see patients who have had significant pain and discomfort during the injection process when local anesthesia is used alone. 

For this reason, many surgeons supplement local anesthesia with I.V. sedation or general anesthesia to minimize pain and discomfort during the procedure. When utilizing this approach patients can have more fat removed and avoid multiple procedures. The procedure is more comfortable and avoids break through pain which can occasionally occur with local anesthesia alone.

It’s important to realize that all surgical procedures and anesthetic techniques have risks. This is true whether local anesthesia, I.V. sedation or general anesthesia are utilized. Most surgeons who perform tumescent liposuction agree that the anesthetic technique utilized is less important than the use of a certified operating room and the presence of an anesthesiologist. In other words, you don’t want your surgeon to be your anesthesiologist.

Liposuction Alternatives – What are the Options?

The most obvious alternative to liposuction is diet and exercise. Unfortunately, many localized areas of fat are refractory to this method of treatment. For this reason, patients often seek other methods of treatment. 

A large variety of non-surgical alternatives are currently available for treating localized collections of fat. Examples include zerona, coolsculpting, mesotherapy, and endermologie. All of these procedures are associated with varying degrees of success, but none are as effective as liposuction.

Liposuction represents the gold standard that all other body contouring procedures are judged against. This procedure is associated with dramatic results and high patient satisfaction rates. In the vast majority of patients, liposuction is still the best option for treating localized collections of fat.

If you’re concerned about localized fat collections, consultation with a board-certified plastic surgeon who has experience with this problem is appropriate. This surgeon should be able to discuss non-surgical and surgical options. Utilizing this approach, an individualized treatment plan can be developed specifically for you.

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. 

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. 

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.  

Wearing Eyeglasses after Rhinoplasty?

We recommend that patients don’t wear eyeglasses for at least four weeks following rhinoplasty. During this period the nasal bones aren’t totally healed and slight pressure can cause distortion, indentation and secondary nasal deformities.

In patients who are dependent upon their eyeglasses alternative strategies are occasionally necessary. When nasal splints are present, eye glasses can be placed directly on top of these stable structures without concern. The splints are usually removed after the first week and other approaches become 

We often recommend taping the eyeglasses to the forehead. In some cases additional padding can be attached to the nasal eyeglass pads as well. 

When patients require eyeglasses to function these maneuvers represent a significant disruption of daily activities. With this in mind, it’s important to remember that the benefits of rhinoplasty will last an entire life time.

Plastic Surgery Financing

For many patients, cosmetic surgery wouldn’t be possible without some type of financing. For this reason, the vast majority of plastic surgeons offer some type of financing program. With the availability of this type of program, plastic surgeons don’t typically take installment payments. They usually require full payment before surgery is performed.

In our practice, we almost exclusively utilize Care Credit. This is currently the most commonly used source of plastic surgery financing in the United States. The company is run by GE Capital. It’s reputable and you can apply for a loan online. It takes approximately thirty minutes to get a response. In some cases, you may be able to get a twelve-month interest-free loan.

Financing isn’t for everyone; make sure you understand the fine print in your contract. Don’t take on more than you can handle. At some point, you will have to repay the loan. It’s important to have all your financing questions answered before proceeding with cosmetic surgery. In our office, we have financial consultants who can help you with this very important issue.

C-Sections & Tummy Tucks

Abdominoplasty isn’t recommended immediately following a C-section for a variety of reasons. These include the inability to make aesthetic judgments immediately following pregnancy, the mother’s overall health status, and the demands of a newborn child on the mother.

The timing of surgery following pregnancy is important and several issues should be considered before proceeding with surgery. It takes time for a new post-pregnancy body to reach its new baseline following pregnancy, and during this transition, it’s impossible to make aesthetic judgments. During this period, stretched skin may contract, a swollen uterus may shrink, and the weight gained during pregnancy may gradually disappear. This process takes 3 to 6 months and needs to occur before abdominoplasty is performed. 

Ideally, patients should be within 10% of their ideal body weight and in good health otherwise. The majority of women who have undergone C-sections aren’t in good physical shape and are therefore not optimal candidates for surgery for a variety of reasons. These may include severe fatigue, a depressed immune system, possible blood loss, an increased potential for infection and elevated estrogen levels which can increase the risk of blood clots.

Finally, the demands of a newborn would make the recovery from these combined procedures very difficult. For instance, the use of postoperative pain medications would prevent you from breast feeding. In other words, the abdominoplasty might impact your developing relationships with your newborn child. 

For all these reasons, it’s obvious that C-section and abdominoplasty shouldn’t be performed together. If you’re considering abdominoplasty it’s important to give yourself time to fully recover from your C-section. Once this has occurred it’s appropriate to consult a board-certified plastic surgeon.  

Plastic Surgery While Menstruating

It’s not unusual for cosmetic surgery patients to express concern about menstruation before undergoing surgery. This anxiety is not warranted. Menstruation has no effect on surgery and doesn't increase bleeding or increase pain levels following surgery. In some cases, patients may have taken non steroidal anti inflammatory agents for treatment of menstrual cramps. Under these circumstances, it might be appropriate to re-schedule surgery to avoid bleeding complications that can be associated with these drugs. 

Mommy Makeover Preparation

The mommy makeover is one of the most extensive procedures performed in cosmetic surgery. For this reason, preparing for surgery in every possible way will not only improve your result, but the quality of the experience as well. It’s important to prepare physically, medically, and mentally for this procedure. 

It’s important to be in good physical condition before proceeding with this procedure. Ideally, results are best when patients are within ten percent of their ideal body weight. Although some patients are unable to reach this goal, they still benefit from the procedure. In addition, it’s also important to maintain good nutrition, exercise regularly, and maintain a healthy life style.

It’s also important to be medically ready for the mommy makeover. Patients should be extensively evaluated to rule out other medical conditions. Areas of particular concern include cigarette smoking, blood pressure management, and the patient’s baseline hemoglobin.

Mental preparation for the mommy makeover is also extremely important and helps lower anxiety levels before surgery. It’s important that you have a comfort level with your anesthesiologist, surgeon, and the surgical facility. It’s essential that all your questions be answered so there are no surprises. 

Arrangements for post-operative care also need to be in order. It’s important to have a care giver not only for yourself, but your children as well. Addressing as many of these issues as possible before surgery will significantly improve results and the quality of experience. 

Compression Garments for Liposuction

Patients who undergo liposuction can expect swelling and discomfort following this procedure. In an effort to decrease swelling, most surgeons utilize compression garments in the postoperative period. Although each patient should be considered individually, we generally recommend three to four weeks of compression following liposuction.

Compression minimizes swelling, minimizes bruising, and decreases postoperative pain. It helps to remodel the soft tissue by collapsing the tunnels created by the liposuction cannula and controls skin shrinkage following the procedure. Compression contributes significantly to the contour improvement seen with this procedure.

Breast Fullness Following Breast Reduction

Some of the most satisfied patients seen in our practice have had breast reduction surgery. These patients note significant improvement in their symptoms as well as improved breast aesthetics. The procedure simultaneously reduces the breast volume, reduces areola size, lifts the breast into proper position, and creates upper breast fullness.  

This is accomplished by leaving attached underlying breast tissue, which supports the blood supply to the nipple areola complex and wrapping it in a tightened skin envelope. Results are usually excellent in the immediate postoperative period. Unfortunately with time, gravity causes the breast tissue to drift downward stretching the skin, creating recurrent sag.

This phenomenon is known as bottoming out of the breast and not only results in sag, but loss of the upper breast fullness as well. This phenomenon is more likely to occur if the patient has thin skin. The amount of sag that the patient has preoperatively and how much breast tissue is left behind are also factors. 

In an effort to minimize the development of recurrent sag and loss of upper breast fullness, surgeons have utilized various maneuvers. Positioning of the breast pedicle to a more superior location has been found to be helpful. Internal suture techniques have been utilized as well. Despite modifications in surgical technique, loss of upper breast fullness may still occur. Despite your surgeon’s best efforts, it’s important to realize that gravity is an unrelenting force.

Swelling Following Breast Augmentation

Patients undergoing breast augmentation can anticipate significant swelling in the immediate postoperative period. This swelling resolves quickly with the vast majority being gone in about three weeks. Almost all of the visible swelling is gone in four to six weeks, but small amounts of residual swelling may be present for up to three to four months following surgery.

Compression bras and dressings are frequently used following breast augmentation to minimize swelling. Swelling can add to a patient’s postoperative discomfort. It can also increase anxiety regarding breast size immediately after surgery.
 
For these reasons, we feel it’s important for the patient and the surgeon to have good communication regarding this topic immediately following surgery. In this situation, a little reassurance can go a long way towards making this a more comfortable experience.

Liposuction & Weight Loss

Liposuction is not a weight loss procedure. The procedure is performed to fix localized fat deposits, which adversely impact body contour.  These fat collections may be located in a variety of locations including the abdomen, hips, thighs, flanks, and arms to name a few.  In many cases these areas don’t respond to diet and exercise.

 

When liposuction is performed, it’s unusual for this procedure to result in weight loss greater than one or two pounds.  Despite this, even when patients are twenty pounds overweight, liposuction can result in improved body contour and high satisfaction rates.
 
When weight loss is the primary goal, a weight loss program would be appropriate.  Consultation with a board-certified plastic surgeon would be a helpful first step. Make sure he or she discusses all of your options and helps determine which one is best for you.

Blurry Vision Following Blepharoplasty

Changes in visual acuity are not uncommon following blepharoplasty. There are several possible causes for changes in vision following this type of surgery. These can include the use of ointments following surgery, dry eyes following surgery, and eyelid skin tightness which can change the curvature of the cornea.
 
Blurred vision can result from the use of topical ointments, which are used for a variety of reasons in the postoperative period. In our experience, the use of eye ointment is the most common cause of blurred vision following blepharoplasty. For these reasons, we recommend the use of ointment at night and drops during the day. 

 

Eye dryness following blepharoplasty can also contribute significantly to vision changes following this type of surgery. This is typically treated with eye lubricant. Usually, eye drops are used during the day and longer lasting ointments are used at night.
 
Finally, tightness of the eyelids against the globe can affect the curvature of the cornea and cause refractory changes. This can be made worse when significant swelling is present.
 
When vision changes occur following blepharoplasty, it’s appropriate to consult an ophthalmologist. With appropriate management of these symptoms, vision usually returns to normal in a matter of weeks.

The Ideal Weight for Tummy Tuck Surgery

There’s no question that being close to your ideal body weight improves the results from tummy tuck surgery. It also decreases the potential for complications with this type of surgical procedure. For these reasons, we prefer that patients be within 10% of their ideal body weight at the time of surgery.
 
Unfortunately, reaching an ideal weight is easier said than done. The vast majority of patients are unsuccessful at losing this additional weight. 

It’s also important to know that even when patients are overweight, they can potentially benefit from abdominoplasty. 

Every patient must be evaluated on an individual basis.
 
We encourage patients to lose weight before surgery and prefer that their weight be stable for at least three months. We realize that some patients will have difficulty losing weight. We therefore encourage patients to be in a supervised weight loss program. Even with that help, some patients will be unsuccessful in their effort to lose weight. 

Even without weight loss, many of these patients will still potentially benefit from tummy tuck surgery.
 
It’s important to realize that weight loss following tummy tuck surgery can affect the final result. This could even result in the need for revisional surgery. For these reasons, it’s important to thoroughly discuss this issue with your board-certified plastic surgeon.

Vote Aesthetic Surgical Images: Best of Omaha 2015!

It’s that time of year again! Best of Omaha voting for 2015 is underway and Aesthetic Surgical Images would be honored to have your vote in the Breast Augmentation & Cosmetic Surgeon categories.

How to Vote:

1. Click Here.
2. Register to vote (you will need to verify your email address).
3. The Breast Augmentation category with Aesthetic Surgical Images filled out will automatically appear for you.
4. For the Cosmetic Surgeon category, please enter the Aesthetic Surgical Images’ surgeon that you think deserves this vote: Dr. John Edney, Dr. Richard Bruneteau or Dr. Marie Montag.

*Please Note: Make sure to verify your email address & vote for at least 15 categories for your votes for Breast Augmentation & Cosmetic Surgeon to count!


Thank you! The surgeons and staff of Aesthetic Surgical Images truly appreciate your support and are incredibly grateful for your votes!


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