Archive for the ‘Body Contouring’ Category

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Scars: What to Expect After Plastic Surgery [Part II: Uncontrollable Factors]

Thursday, January 19th, 2012

Any time an incision is made there will be a permanent scar. As I discussed in Part I of this blog series, when I perform Phoenix area plastic surgery, I take all possible precautions to ensure that scars will heal smoothly. In addition, I advise my patients on what they can do during their recovery process to minimize the appearance of scars. Unfortunately, some factors are outside our control.

First and foremost, genetics is the greatest uncontrollable factor. Everyone scars differently. The same surgeon can perform the same surgery using the same technique on two different patients and get completely different scars. Simply put, some people heal more smoothly, while others have a tendency to form more noticeable scars.

Patients who have a personal or family history of bad scarring should be cautious about surgery. A genetic tendency toward severe scarring can affect not only the external, visible scar tissue but also the internal scar tissue.

Many people of Asian, African, Middle Eastern and Mediterranean descent are more prone to scarring. However, these are general findings, and every individual heals differently regardless of his or her ethnicity. Some Caucasians form thick, red scars while some African-Americans form nearly invisible scars.

Another factor affecting scarring is body location. Certain areas of the body tend to heal with thicker scars. The center of the chest, the shoulders and the back are notorious for bad scars because of the thick, tight skin. This is why surgeons try to avoid incisions in these areas. If, for some reason, an incision must be made in one of these areas, there is a higher risk for thicker or more noticeable scars.

Tension on a wound closure also can contribute to scarring. The more the skin is being pulled, the higher the likelihood that the patient will develop a bad scar. This is one reason why plastic surgery is so challenging; almost everything we do requires tension. Unlike a C-section or an appendectomy, where no skin is removed, breast reductions, tummy tucks and facelifts all require skin removal, which causes more tension to be placed on the wound closure.

To counteract this, plastic surgeons pay a lot of attention to layered closure and fine suturing techniques. One could argue that tension is a controllable factor. However, to a large degree, the surgeon cannot control tension. To achieve the desired result, a certain amount of tightening is required with procedures such as a breast lift or a tummy tuck in the Phoenix area.

Some other causes of scarring also cannot be fully controlled. These include wound infections, problems dissolving internal sutures and other healing challenges. If one of these problems occurs, the patient and surgeon can work together to improve the situation.

I hope I have helped explain one of the most unpredictable and important aspects of plastic surgery. I always do everything I can, both during and after surgery, to minimize scars. Most of my patients heal extremely well and are happy with their results, including their minimal scars. Although some people will develop less than ideal scars despite my best efforts, the majority of such patients are still happy with the overall results of their surgery.

The bottom line is that everyone considering elective surgery must be realistic about the possibility of having more visible scars than they would like and understand that this is a low – but real – risk.

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Scars: What to Expect After Plastic Surgery [Part I: Controllable Factors]

Wednesday, January 11th, 2012

As a plastic surgeon in the Scottsdale area, one of the questions I often hear from patients is: “What will my scars look like?”

Obviously, scars will be a concern for patients having extensive surgery, such as a tummy tuck or a breast lift, but patients having less invasive surgery, such as liposuction or breast augmentation, still worry about their scars.

The truth about scars is that there are some aspects the surgeon can control, while other aspects cannot be controlled. Keeping that in mind, the first part of this two-part blog series will discuss the controllable factors, and the second part will discuss the uncontrollable ones.

Controllable factors mostly have to do with surgical technique and postoperative care. During surgery, it is important for the surgeon to be as gentle as possible with the tissues. Rough handling of the skin, overuse of cauterization and imprecise incisions can certainly cause extra scarring. In addition, poor suturing techniques, the types of sutures used and how carefully the sutures are placed can affect scar healing.

When I perform a procedure such as a tummy tuck in the Phoenix area, I am extremely meticulous about how I handle tissue in order to cause the least amount of trauma possible. I also take time during the closure to make sure the tissues and skin line up as cleanly and smoothly as possible. Finally, for all but the smallest surgeries, I do multiple layers of suturing with dissolving, under-the-skin sutures to avoid any stitch marks in the skin. I use longer-lasting deep sutures to take tension off the skin-surface sutures, which reduces the possibility of scar spread.

Controllable factors after surgery include minimizing the risk of infection, scar massage, using ointment in the early period and using silicone sheeting or steroid injections if necessary to flatten scars. For my patients’ follow-up visits after surgery, I always see them personally to evaluate the scars and advise them on what can be done to minimize the visibility of scars.

It’s important to understand that scars fade over time. As you heal, your scars will become less visible.

One final idea I would like to share is that patients can take part in their own healing process to minimize scars. It is very important to follow post-op instructions, including these recommendations:

  • Do not exercise too soon. This can put strain on the tissues.
  • Avoid smoking after surgery. Smoking impairs wound healing.
  • Avoid UV exposure or tanning of scar areas for a full year to minimize scar darkening.
  • Massage your scars for a few minutes each day to help them soften. Products such as Mederma®, which are marketed specifically for reducing scars and stretch marks, are fine, but studies have not shown a huge improvement in long-term scarring. If patients want to use these products, I do not discourage them as long as I know exactly what they are putting on their scars. Some products, such as topical vitamin E, have been shown to cause more harm than good.

In Part 2 of this blog series, I will discuss factors related to scarring that are outside our control.

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Can I Have a Tummy Tuck Immediately After my C-section?

Tuesday, January 3rd, 2012

Can I Have a Tummy Tuck Immediately After my C-section?
Many women considering a tummy tuck in Phoenix or Scottsdale are new moms who want a flatter abdomen after pregnancy. While it is possible to have a tummy tuck after childbirth, the surgery should be reserved for the appropriate time.

As seen by the ever-growing number of Mommy Makeover patients at my plastic surgery office near Phoenix , more and more women are ready to look and feel their best after having kids.  Additionally, these women are busy with so many things that they want to get multiple surgeries done simultaneously in order to minimize recovery time and time off work.

While combining breast surgery and abdominoplasty has been shown to be safe (a topic I have researched and presented extensively in plastic surgery journals), not all combination surgeries are appropriate.

Patients will frequently call my office to ask if I can combine a tummy tuck with a planned C-section.  While the idea of having a child and leaving the hospital with a flatter, tighter abdomen is appealing, this is a bad idea for multiple reasons.

Abdominoplasty is major surgery that should be performed on patients when they are in peak health and are on a good diet and exercise program in order to get the best results. At the end of a pregnancy, most women are nutritionally depleted, as so much of their energy is going to support their developing baby.  Also, many women are sleep deprived and physically exhausted by the long pregnancy. This is not an ideal time to perform an elective surgery.

Additionally, at the end of pregnancy, women are very edematous (swollen), and the abdominal skin and connective tissue is very stretched out.  It can often take women 6 to 12 months to return to a normal baseline weight and tightness. This is the appropriate time to perform a tummy tuck in order to get the best result.

Finally, during a C-section, the baby is delivered through an abdominal incision. This is accompanied by amniotic fluid, and possible meconium (stool from the baby).  It is important when performing an abdominoplasty to have a sterile surgical field, and this would be severely compromised by the fluids in the uterus.

Although convenience is important, safety and good results are much more critical. This is why I always recommend that patients undergoing a C-section allow themselves to heal, recover nutritionally and get in the best shape possible after their delivery before they consider abdominoplasty surgery.  If the proper precautions are taken, I can achieve the best, most aesthetic results in the safest way possible.

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Do I Need Liposuction or Abdominoplasty?

Monday, January 10th, 2011

This is a question I encounter quite frequently. Women and men often come to my office in Scottsdale for liposuction thinking that it will help to correct their protruding belly. Liposuction is a far more common procedure than abdominoplasty, so it makes sense that people are more familiar with this option. And, frankly, liposuction has a much shorter surgical and recovery time than abdominoplasty, so naturally it can be a very appealing choice.

If the patient has excess, stretched skin, liposuction may actually make the midsection look worse. Instead, a tummy tuck removes the skin and in some cases stretch marks. Often when a person has a bulging tummy, the underlying muscles have separated – either from pregnancy or excess weight – and this diastasis needs to be surgically repaired. Liposuction is simply not the right treatment for a person with abdominal wall muscle laxity and excess skin. It can, however, improve the results of a tummy tuck by contouring the waist, abdomen and flanks.

Liposuction alone may be a good option for people who have good skin and muscle tone, but have a protruding belly caused by stubborn, isolated fat alone. In patients such as these, liposuction can reduce love handles, flatten a bulging abdomen, and sculpt the waist for a more pleasing body shape.

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Posted in Abdominal Etching, Body Contouring, Cosmetic Surgery for Men, General Plastic Surgery, Liposuction, Mommy Makeover, Tummy Tuck, Uncategorized | No Comments »

Getting Behind the Wheel

Wednesday, October 20th, 2010

You wouldn’t drive drunk, and you’d pull over if you were falling asleep while driving. So, if your surgeon tells you it’s not safe to drive after surgery, you’d follow their instructions, right? After plastic surgery some patients choose to get behind the wheel before being given the green light from their surgeon, but it’s important to understand and appreciate the reasons a doctor may choose to limit a patient’s driving privileges.

  1. Medications. The medications used as anesthesia during surgery and the medications used to control pain after surgery are drugs that slow reaction times and induce drowsiness. Of course, this isn’t a problem if you’re being a model patient and lying on the couch or in bed, but it does become a problem if you’re trying to operate a motor vehicle.
  2. Distraction. When you’re driving, the last thing you need is a distraction. Unfortunately, if you’ve just had surgery and you’re trying to sit up to drive, you may get just that. Pain is, to some degree, inevitable after certain procedures and can be made worse by overdoing it or sitting in an uncomfortable position. If a pang of pain hits while you’re driving, the consequences of the distraction could be very serious.
  3. Vision. After eyelid surgery, a brow lift, and some other procedures, the area around the eyes can be swollen. Swelling in the eye area can impair vision. Obviously, you need to be able to see in front of you and around you when you’re driving. If you can’t see, you can’t drive.

So, let’s think of ways to help you avoid the temptation to drive after surgery. A good, very general rule is to be prepared for your recovery. (You can read my blog about recovery prep here.) More specifically, I think the best way to avoid situations where you’d be tempted to drive is to have a friend or family member “on call” to assist you during your recovery. This is helpful for many reasons, not just for driving. In addition to being your driver, your recovery buddy can run errands for you, help you with household chores, prepare food or beverages, and much more.

Driving isn’t prohibited after every procedure. In fact, there are plenty of minimally invasive treatments like BOTOX® Cosmetic injections or minor scar revisions (as opposed to larger surgical procedures in Scottsdale, such as liposuction or a tummy tuck) that allow you to get back to your usual routine – including driving – right away. But, for those procedures that do leave you “grounded,” your safety and the safety of those around you depends on you following doctor’s orders.

If you’ve had surgery and were told not to drive, what arrangements did you make? Do you have any tips for other patients?

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