For Meghan Trainor it’s, “All About That Bass.” Her song has frequently gotten stuck in my head, and apparently in many other heads, too. She has reached number 1 on the US Billboard Hot 100, and just announced the That Bass Tour which is scheduled to begin on February 11, 2015 in Vancouver, Canada and end on March 20, 2015, in Nashville, Tennessee. Not too shabby for a 20-year-old.
All About That Bass
There has certainly been more attention paid to the booty in recent years. In Plastic Surgery, the Brazilian Butt Lift continues to be a hot topic. More and more are done each year as techniques improve. However, if you look at the numbers, it’s still more about the treble.
Can’t Ignore the Treble
I like to keep things positive, so for me, Meghan’s “debut” single is all about appreciating assets rather than dissing flaws. It’s important to appreciate and admire our favorite features, but for Plastic Surgery balance is more important.
The Golden Ratio
Beauty is all about proportions. Math might not be the first subject that comes to mind when you think of beauty, but our brains are tuned to both symmetry and mathematical ratios. The most well known is the Golden Ratio. If you draw the perfect rectangle, the ratio of the sides will be the golden ratio. If the short side has a length of 1, the long side will have a length of 1.618. The number 1.618 is represented by the Greek letter phi.
Phi for Phidias
1572 engraving by Philippe Galle of Phidias’ enormous Statue of Zeus at Olympia
It was a mathematician, Mark Barr, who proposed using the first letter in the name of Greek sculptor Phidias to symbolize the golden ratio. Phidias was the creator of one of the seven wonders of the world – The Statue of Zeus at Olympia, and many of the carvings in and around the Parthenon. He used the Golden Ratio to great effect; creating beautiful sculptures of the human form.
It’s All About the Face Too
The Golden Ratio applies to the body and the face.
The Golden Ratio is not just about the body. It can be applied to the face, also. The faces above have a Golden Ratio Mask superimposed. The top row shows classic beauties going all the way back to Nefertiti (ca. 1370 BC – ca. 1330 BC). The middle row illustrates more modern beauties: Angelina Jolie, Audrey Hepburn and Marilyn Monroe. The ratio applies across nationalities as the Asian, Caucasian and African faces demonstrate on the bottom row, and applies equally as well to the male face below.
The Golden Ratio Mask applies equally as well to the masculine face.
Balance and Harmony Trumps Absolutes
The same Golden Ratio is found everywhere in nature, and not just in animals. Plants grow, and flowers bloom with the same attractive proportions. If you are considering Plastic Surgery, keeping the Golden Ratio in mind, or at least in your Plastic Surgeon’s mind, is important to obtaining optional results. Even for a simple lip plumping, the upper lip height is a 1, and the lower lip height is 1.618. We can all recognize this, and it is why when only the upper lip is augmented, the results are not as attractive. Attention to the proportions is important to a pretty, and natural, result.
For a private Plastic Surgery Consultation in the San Francisco Bay Area, give me a call at (925) 943-6353, or contact my Walnut Creek, CA, office via the contact form in the left margin.
Today is Veteran’s Day, a day honoring the men and women who have provided military service to their county. I’d like to send a personal thank you to my father, my uncle and other friends who have risked it all to protect these United States of America.
Why November 11th?
Front Page of the New York Times on November 11, 1918. Above the title it says “twenty-four pages” and the price, “two cents in the 10 miles radius of the metropolitan district, three cents within 100 miles and four cents elsewhere.”
November 11, 1918, is generally regarded as the end of “the war to end all wars,” i.e. World War I. The official end of WWI was June 28, 1919. This is when the Treaty of Versailles was signed; however, fighting ceased seven months earlier when a temporary cessation of hostilities, an Armistice, between the Allied nations and Germany went into effect on the eleventh hour of the eleventh day of the eleventh month. It was still a bloody day as 10,944 casualties including 2,738 who died on this, he final day of fighting. The last American was killed at 10:59 AM.
But I Thought it was Armistice Day
US 64th Regiment, 7th Infantry celebrate the first Armistice Day.
In November 1919, President Wilson proclaimed November 11 as the first commemoration of Armistice Day. The original concept for the celebration was for a day observed with parades and public meetings and a brief suspension of business beginning at 11:00 a.m.
It Was Armistice Day
In 1938, congress proclaimed the 11th of November a legal holiday – a day to be dedicated to the cause of world peace and to be thereafter celebrated and known as “Armistice Day.” It was a day to honor veteran’s of WWI. Unfortunately, WWI was not the war that ended all wars, so in 1954, the act was amended by replacing Armistice with Veteran’s. For the last 60 years, November 11th has been Veteran’s Day, a day to honor American veterans of all wars.
It Still is Armistice Day
The hillside near the Lafayette, CA, BART station is a large reminder that war continues to happen, almost 100 years after the end of the war to end all wars.
November 11th is still celebrated as Armistice Day in many nations. People observe one, or more commonly, two minutes of silence at 11:00 a.m. local time as a sign of respect. The first minute is for the roughly 20 million people who died in the war, and the second minute is dedicated to the living left behind. The holiday has also evolved into Remembrance Day and Poppy Day, in other nations.
How to Support Veterans
How can you support a Veteran? The five word title of this article is a good place to start. Thanking a veteran for his or her service is always appreciated. Like many of my favorite Plastic Surgery procedures, it is direct, simple and effective.
Organizations that support our troops range from local, like the Blue Star Moms in San Ramon and Danville, CA, to national, like the Wounded Warrior Project; from broad to specific, like the Navy Seal Foundation; from active duty, like the USO, to retired. There are many ways to support our Veterans, and no better day than today.
Many people have Plastic Surgery, but is it safe for “old” people? Should there be an age limit on Cosmetic Surgery? Recent research shines a spotlight on the question, and what is reveals is very encouraging.
How Old is Too Old for Plastic Surgery?
The woman above is a patient of Dr. Suzanne Noel, a French Plastic Surgeon who was doing “lunchtime facelifts” in her apartment one-hundred years ago.
How old is too old for Plastic Surgery? is a question I hear every week in my San Francisco Bay Area Plastic Surgery Office. My standard answer has always been that your health is more important than your age, and research presented at this year’s American Society of Plastic Surgeons meeting in Chicago backs that up.
Dr. Suzanne Noel, pictured above, was a gifted Plastic Surgeon and one of the first to perform outpatient surgery. Thankfully, today we use gloves. In 1924 she founded Soroptimist International Paris, the first Soroptimist club in Europe. The first Soroptimist club was founded in 1921, in nearby Oakland, California.
How Old is Old?
For me, every year “old” gets a little older. For the paper, Safety of Cosmetic Procedures in Elderly and Octogenarians Patients, the young group had an average age of 39 (+/- 12.5 years), and the elderly group had an average range of 69 (+/- 4.1 years). Investigators reviewed the outcomes of 183,914 people who underwent cosmetic surgery.
Differences Between the Young and Elderly Groups
There were some interesting differences between the young and elderly groups besides their age. There were more men in the older group (11.3% vs 6.2%), and the older group was a little heavier (average BMI 25.4 vs 24.2). There were more diabetics in the older group (5.7% vs 1.6%) and fewer smokers (3.4% vs 8.5%).
Different Folks Different Strokes
The Mommy Makeover, in this case Breast Augmentation plus a Tummy Tuck, is more often performed for younger women who are finished having children.
The two age groups also had different types of procedures. Younger women for example have more Tummy Tucks and Breast Augmentations and don’t need many Face Lifts. As expected, the elderly group had more Facial Plastic Surgery (69.2%) than their younger peers (12.0%).
Facelifts are more common performed after age 50, to reverse the sequela of aging: jowls, deep naso-labial folds and sagging neck skin.
And the Complication Rate is…
The most common complications with any surgery are bleeding (hematoma), infection and wound healing problems. The study revealed there was no difference in complications between the two groups. The complication rate for the younger group was 1.94%, while the complication rate for the elderly group was 1.84%. Even when selecting only the octogenarians, the complication rate was 2.2%, and still not statistically different from the younger group’s results. Each procedure was examined independently, and only the Abdominoplasty had a higher incidence of complications in the older group (5.4% vs 3.9%), so get your Tummy Tucks early.
Board Certified Plastic Surgeons
This study was for a group of patients operated on by Board Certified Plastic Surgeons. The selection of patients who are good candidates for Plastic Surgery includes more than the fact that someone wants surgery. It includes objective and subjective evaluations about safety and predictability. The was no data available for the number of patients who were declined Cosmetic Surgery because of health concerns. This study looked only at a group of patients who Plastic Surgeons felt were safe to have their selected procedures. It is not clear if the outcomes would be the same if another group of providers were making the selection.
If you are considering Plastic Surgery, select a Board Certified Plastic Surgeon with experience performing your desired Cosmetic Surgery. If you are seeking a Plastic Surgeon in the San Francisco Bay Area who specializes in Cosmetic Plastic Surgery, give me a call at (925) 943-6353, or contact me through the contact form in the margin.
This week, I am continuing to talk about Breast Augmentation, specifically Breast Implant Deflation. As mentioned in last week’s post about Saline Breast Implant Deflation, Silicone Breast Implant Deflation is quite different. A Saline Breast Implant is essentially filled with water. Saline is slightly salty water (0.9% NaCl) that matches the saltiness of our bodies. When saline leaks out of the implant, it is absorbed. Saline quickly disappears without a trace, and it is not dangerous.
Saline or Silicone? Saline and Silicone Breast Implants feel different, but give similar results visually.
Get to Know Your New Silicone Filled Breast Implants
Modern Silicone Breast Implants are filled with a soft, but nearly solid, silicone gel. The consistency is like a soft, “indestructible,” stress ball. The latest high strength, highly cohesive silicone gel breast implants are also form-stable. This means they maintain their shape. The phenomenon is similar to Gummy Bear candies. These soft bears can be compressed flat, and will return to there original bear shape once released. This is why the latest silicone breast implants are frequently referred to as Gummy Bear Breast Implants. The video below makes it clear what happens when there is a hole in the shell of a silicone breast implant.
Video of the Inside of a Gummy Bear Breast Implant
This Breast Implant Rupture Video demonstrates what happens to the silicone filled breast implant’s contents after massive failure of the breast implant’s shell. Even when cut completely in half, the gel maintains its shape and integrity. It is soft, but does not flow. The high strength silicone gel changes shape easily when squeezed, and returns to its original form when the deforming force is removed. High tech meets high aesthetics.
Not Your Mother’s Breast Implants
Gummy Bear Breast Implants are a giant leap forward from the older silicone filled breast implants. Breast Implants manufactured before 1985 were filled with a silicone gel that behaved more like a liquid than a solid. When the breast implant ruptured, the silicone oil/gel would migrate into the breast and cause lumps of scar tissue. After 1985, the gel was made more cohesive, and the shells were made stronger. Implants after 1994 are less likely to leak, have very little “gel-bleed” (the ability of the gel to pass through the shell like helium through a balloon), and the gel inside them is less likely to migrate. If you are interested in the older breast implants, check out the History of Breast Implants.
Who Makes the Strongest Breast Implants?
Sientra’s newest breast implant line contains the strongest silicone gel to date, yet it remains soft.
The implant manufacturer which currently has the strongest silicone gel is Sientra. Their five-year follow-up data shows zero cases of gel migration. As a Board Certified Plastic Surgeon specializing in Breast Augmentation Revisions, who has spent many an afternoon cleaning up pre-1985 ruptured breast implants, this is welcome news. This means if your modern silicone filled breast implants rupture, the gel will not immediately begin to migrate, and has a very high likelihood of staying in the pocket. But this causes a different problem, which I discuss below under “Silent Leaks”.
Silicone Breast Implant Deflation
Silicone Breast Implants Deflations should always be addressed as soon as it is medically safe. Unlike with Saline Breast Implants, delaying correction can cause more problems than just the pocket tightening, especially if you have older technology Silicone Breast Implants.
Silicone, unlike Saline, does not absorb into the body. Instead, the body tries to contain it by making a pocket of scar. For an intact Breast Implant, this works very well. The pocket surrounds and supports the implant, keeping it in the desired position. When a Silicone Breast Implant Ruptures, initially the gel remains within the breast implant’s pocket. With newer highly cohesive and gummy bear breast implants, the gel tends not to flow.
Older Breast Implants Are Messy When they Leak
For older, pre-1994, silicone filled breast implants, long term studies show that the more liquid-like silicone gel in older breast implants can migrate outside the pocket on the order of 14% per year. This means that if we follow 100 women who have older silicone gel filled breast implants that are already ruptured for one year, fourteen of them will develop gel migration outside the containment of the breast implant pocket. This gel migration may become evident as a change in shape of the breast implant, sudden softening of the implant, or lumps in the breast as the body tries to form a new pocket around the leaking gel.
Silent Silicone Breast Implant Leaks
The latest generation of breast implants have a strong, fairly solid center. The scar pocket contains this highly cohesive gel, much like the breast implants shell does, even after there is a leak. This makes it difficult to tell when the implant has leaked on physical examination. This is termed a silent leak, something that cannot happen with saline breast implants. What problems a silent leak can cause when the gel is still contained are not clear, but it is recommended to have any Leaking Silicone Breast Implant replaced before it can cause the problems outlined above. The FDA has recommended obtaining an MRI at three years, and then every two years after breast augmentation with silicone breast implants. With the data coming from the long-term breast implant follow-up studies showing reduced or no gel migration with the newest generation of breast implants, this recommendation may be modified in the future.
Breast Implant Revision Surgery
Breast Augmentation remains the most popular Cosmetic Plastic Surgery. While many women will keep their original implants for life, other will benefit from Breast Implant Revision Surgery.
If you are considering Breast Implants, or would like Breast Augmentation Revision, a Board Certified Plastic Surgeon is your best bet for a great result. If you are near the San Francisco Bay Area, give me a call in Walnut Creek, California, at (925) 943-6363, or use the contact form to the left for more information.
There is a big difference between Breast Implant Deflation for Saline versus Silicone filled Breast Implants. A deflated Saline Breast Implant is illustrated below. Since saline is water that is slightly salty (0.9% NaCl) to match our bodies, it is not dangerous and is quickly absorbed. Saline is necessary for life. The IV bag of saline used to inflate breast implants is exactly the same bag used to resuscitate people who are dehydrated.
Saline Breast Implant Deflation Before and After Photos
The dramatic asymmetry above was caused by deflation of the left breast’s saline filled breast implant. While the saline is quickly and safely absorbed, its exit rapidly returns the breast to its pre-augmentation size. The after photo shows the result after breast implant replacement surgery.
The shell of a Saline Breast Implant is strong, so they do not leak often. When they do; however, it is safe but it is not subtle. More on this below under Saline Breast Implant Deflation.
Silicone Breast Implant Deflation: More Next Week
Modern Silicone Breast Implants, while soft, are nearly solid. The latest high strength, highly cohesive silicone gel breast implants are form stable. This means they maintain their shape. The phenomenon is similar to Gummy Bear candies. These soft bears can be compressed flat and will return to there original bear shape once released. This is why these implants are frequently referred to as Gummy Bear Breast Implants. The newest silicone breast implants are filled with a gel that is unlikely to migrate, but causes a different problem with surveillance, which I will get to next week when we discuss Silicone Breast Implant Deflation.
Saline Breast Implant Deflation
Saline Breast Implant Deflation while disappointing, is not dangerous. It is rare for a saline implant to partially deflate, so the augmentation of the effected breast is lost rapidly, usually in 24 hours. While replacement is not an emergency, there are several advantages to performing the Breast Implant Replacement sooner rather than waiting.
Immediate Breast Implant Replacement
This woman developed a collection of blood (a hematoma) around her ruptured breast implant after trauma. Urgent breast implant replacement was performed before the hematoma became infected or leaked through the skin.
Reasons for Early Breast Implant Replacement include not only the rapid restoration of appearance, but early intervention prevents the “pocket” from shrinking. The pocket is the thin capsule of scar that surrounds and supports the Breast Implant. This pocket is important in preventing the breast implant from moving. Too thin a capsule will allow the implant to “bottom-out.” While too thick a capsule will compress the breast implant, making it hard. This situation is termed Capsular Contracture.
Late Breast Implant Replacement
If a Saline Breast Implant has been deflated for months, the capsule will gradually tighten around the deflated breast implant shell. The shell can fold irregularly, and these folds may become visible. Some patients even complain of discomfort from the folds poking them. After the capsule shrinks, it will no longer accommodate the replacement breast implant. To make room, the pocket is enlarged (a capsulotomy) or removed (a capsulectomy) to create a pocket of adequate size.
When a breast implant remains deflated for a long time, the skin and the pocket around the implant often shrink. This before and after picture show improved symmetry after breast implant replacement surgery.
Delayed Breast Implant Replacement may have both financial and medical causes. Looking for the lowest price in Plastic Surgery is not usually a good idea. It is alway a good idea to check with your Plastic Surgeon or your Breast Implant Manufacturer about your Breast Implant Warranty. The link provides some of the basic information, but breast implant warranties change from time-to-time, so be certain to get the latest information. If you are having Breast Augmentation, be certain to check your options. Some manufacturers offer enhanced warranties, which need to be purchased within 30 days of the initial Breast Augmentation. These warranties can be very helpful if you have a leaking breast implant as they offer not only a new implant, but money toward the surgery to replace them.
Why Delay Breast Implant Replacement?
Sometimes it is necessary to delay Breast Implant Replacement. Medical reasons include: pregnancy, active infection, breast implant exposure or untreated breast cancer. The timing of Delayed Breast Implant Replacement is guided by the clinical course. Sometimes, Breast Implant Removal is the best option. This is most often recommended for breast implant infections or in cases when the skin breaks down over the implant. The timing for Breast Implant Replacement in cases where implants need to be removed and left out is guided by both the clinical course and your desires. Usually, it is best to wait three, six or even twelve months before attempting replacement of the breast implant.
Breast Implant Repair
As you can see there are lots of options and details to consider with breast implant replacement, and we haven’t discussed Silicone Breast Implants, yet. If you need breast implant replacement, it is also a good time to address all the current breast augmentation options. Some patients will take advantage of the opportunity to switch from Saline to Silicone. Others, who have had some issues regarding asymmetry or breast sagging, will choose to take care of it simultaneously.
If you are in need of Breast Implant Repair, drop me a note via the contact form on this page, or call my San Francisco Bay Area office in Walnut Creek, California, at (925) 943-6363. More next week on Silicone Breast Implants.
Do Breast Implants cause breast cancer? At the risk of ruining the suspense, the answer is still no. Breast Cancer affects 1 in 8 women over their lifetime, and women with and without breast implants have the same risk. If your mother or sister have breast cancer your risk of having breast cancer is increased; however, only 20% of breast cancer patients have a family history of the disease. In other words, 80% of breast cancer is spontaneous.
The Best Cancer Defense is Finding it Early
Amy Robach preparing for her first screening mammogram at age 40.
Like most cancers, Breast Cancer is easier to treat if found early. Early detection means smaller tumors which are less likely to spread, and more likely to let you live a long life. If you find a lump in your breasts, get it checked out by your doctor. The only way to know what a breast lump is for certain is to sample it. Needle biopsies have come a long way, and diagnosis of a suspicious lump can be quick and easy in many cases.
What About the Breast Cancers We Can’t Feel?
The best screening test for breast cancer remains the Mammogram. New techniques can detect smaller tumors earlier, and reduce unnecessary biopsies. The current recommendation for healthy women without a family history of Breast Cancer is to get your first mammogram at age 40. Amy Robach (pictured above) learned the value of the screening mammogram when she received her first mammogram at age 40 as part of a story about Breast Cancer Screening. The test potentially saved her life by detecting a breast cancer before there was any evidence of the disease.
When to Get Your First Mammogram
The mammogram on left is of normal glandular breast tissue. The white circle in the mammogram on the right is breast cancer.
The American Cancer Society, The American College of Surgeons, The American College of Obstetricians and Gynecologists, The American College of Radiology and The Society of Breast Imaging all recommend that routine mammograms begin at age forty for women with an average risk of breast cancer. Women with a strong family history of breast cancer should have their first mammogram 10 years prior to the age that their relative was when they developed breast cancer. On the other hand, the federal government’s USPTF recommendations are to wait until age 50, no breast ultrasounds and no mammograms after age 75. Unfortunately, the USPTF’s recommendations are based on older methods of mammography, and fly in the face of the recommendations made by doctors who care for women every day. The same doctors who continue to make strides battling breast cancer.
Worldwide, there have been 71 documented cases of patients with anaplastic large cell lymphoma (ALCL) in women who have breast implants. This type of ALCL found around Breast Implants is completely different than the usual ALCL, in that it usually has a more benign course, and that removing the breast implants and their capsules has been curative with and without other treatments.
ALCL is normally found in the lymph nodes, as well as in skin, lung, liver and soft tissue, but not usually in the breast. This is a previously unrecognized, new subtype of ALCL. Cases in which ALCL developed in the breast region often involved patients who have had breast surgery, and arose in the scar tissue. Often, many years were required for the tumor to develop, and in the case of Breast Implants, a collection fluid around the implant, rather than a mass, leads to the diagnosis.
ALCL is not Breast Cancer
Anaplastic Large Cell Lymphoma
ALCL arises from lymphocytes (white blood cells), not breast tissue, so mammograms are not useful for diagnosis. Breast Implants are generally safe and studies have found no association between breast surgery and other forms of cancer. ALCL itself is also an extremely rare occurrence. Among three million breast implants, there are between one and six reported cases of ALCL.
What Causes ALCL of the Breast?
Determining the cause of ALCL is made difficult because it is so rare. While the tumor has been found associated with breast implants, it is unclear if Breast Implants are the cause, or if breast implants make the diagnosis apparent. Several mechanisms are under investigation including an abnormal immune response from the body. American, National and International Plastic Surgery Societies are raising awareness for this rare disease among their members, and are repeatedly soliciting their members for new or suspected cases, and compiling a database to help investigators get to the root of the problem. Breast implants, medical implants in other parts of the body and even dentures are being investigated for any link to this rare tumor.
Plastic Surgery and Breast Cancer
Fortunately, plastic surgeons get to help with the healing after the Breast Cancer is removed. As the results of Breast Reconstruction improve, the procedure becomes more popular. Some women, like Amy Robach and Angelina Jolie, are even electing to have both breasts removed and reconstructed. This is usually done when women are at higher risk for breast cancer in the other breast. Since genetic screening for breast cancer is relatively new, not enough time has passed to show any survival benefit to bilateral mastectomies. However, it does provide peace of mind for women who feel their breast is ticking time bomb.
Breast Implants Help After Breast Cancer
The most common way to reconstruct the breast after a mastectomy is with a breast implant. In the year 2000, 78,832 women underwent breast reconstruction, and in 2014 the number will be closer to 100,000. Millions of women have benefited physically and emotionally from these procedures. But with early detection, we can reduce the number of mastectomies performed, and increase the survival for breast cancer patients.
Breast Augmentation vs. Breast Reconstruction
New research confirms what plastic surgeons have known for years. Breast Augmentation does more for a woman than just enlarging her breasts.
Breast Implants are used three times more often for elective Breast Augmentation than for Breast Reconstruction. Breast Augmentation helps with the fit of clothing, provides high patient satisfaction and has been shown to provide significant improvement in quality of life for both elective breast augmentation and breast reconstruction after breast cancer. While breast implants do not cause breast cancer, there are risks and benefits that need to be discussed with a qualified Board Certified Plastic Surgeon. In most cases, the benefits will outweigh the risks, but the decision should always be individualized.
Breast Implant Consultations
If you are considering Breast Augmentation, and live in or near the San Francisco Bay Area, give us a call at (925) 943-6353. An in-person, confidential consultation is the best way to find out if Breast Augmentation is right for you.
This week’s Plastic Surgery Video comes from KRON 4’s Body Beautiful and covers a very specific area of concern seen most frequently after weight loss: the Arm Lift. Also know as Brachioplasty, the Arm Lift tightens the skin of the upper arm which can be over stretched with weight gain.
The Arm Lift Video Presentation below shows many Arm Lift Before and After Pictures. The examples are narrated to describe the specifics in each case. Arm Lifts are a common procedure after Bariatric Surgery or after any large weight loss that leave the arms loose.
Brachioplasty (Arm Lift) Video Presentation
Arm Lifts with Liposuction
When the upper arm is disproportionate due to excess fat and the skin is tight, Liposuction may be all that is needed. Liposuction removes extra fat through small incisions strategically placed in the normal contours of the body. For arm Liposuction, the scars are placed about the elbow or in the axillary regions. For Liposuction of the arms to be effective, the fat must be disproportionate and the skin must have good elasticity. When the skin is loose, removing the underlying fat will enhance the laxity and make the skin fold unpredictably. For loose skin, the Arm Lift is usually the only effective option.
Brachioplasty – Changing the Arms
After massive weight loss, like with the weight loss seen after Bariatric Surgery, much of the upper arm fat disappears. The arm skin, on the other hand, tends to stick around. The excess upper arm skin can be so excessive that the arm remains tight in a sleeve, long after the fat has gone. I have had many patients ask for help with their arm skin laxity. They want to feel comfortable; they want to fit in their clothes, and they want their arms to stop waving when their hands do. Sometimes called Bat Wings, excessive upper arm skin can be a source of frustration and embarrassment long after the weight is lost.
How is the Arm Lift Performed?
The Arm Lift or Brachioplasty is a Cosmetic Plastic Surgery procedure that removes excess skin from the arm. It is performed as an outpatient procedure in an accredited surgery center and takes a few hours. The skin excess is carefully marked for removal with the patient awake and upright so that just enough skin remains to comfortably cover the arm. In the operating room, the excess skin is excised, and the tightened, leaving a carefully closed incision along the underside of the arm. The arm is supported with a compression garment after surgery, and Embrace Scar Therapy is often used to support the repair, speed healing and maximally improve the appearance of the scar. Most patients are back to their normal activities in one to two weeks with few limitations.
Post Bariatric Plastic Surgery
Brachioplasty is frequently performed in conjunction with other Post Bariatric Plastic Surgery procedures. While Bariatric Surgery can cause weight and fat loss, it does not always leave the skin tight. In fact, as we gain weight the excess fat, expands the skin and which grows to cover the increased surface area. When the weight is lost, the skin will shrink, but usually not completely. It is recommended to wait one year after Bariatric Surgery to allow the skin to shrink maximally and the body to heal before having any Plastic Surgery Skin Tightening procedures.
The American Society of Bariatric Plastic Surgeons (ASBPS)
The American Society of Bariatric Plastic Surgery is dedicated to shaping the body after massive weight loss.
If you have lost a significant amount of weight or have completed Bariatric Surgery and are looking to remove loose skin, members of the ASBPS are America’s body contouring specialists. Post Bariatric Plastic Surgery procedures we perform include:
Schedule your Arm Lift Consultation today by calling (925) 943-6353. During your visit to our San Francisco Bay Area Plastic Surgery office in the East Bay city of Walnut Creek, CA, we will discuss your options for treatment and what you can expect from the Brachioplasty procedure. As a Board Certified Plastic Surgeon, and an ASBPS member, I can offer a wide range of skin tightening treatments after weight loss, as well as other Cosmetic Plastic Surgery procedures.
Liposuction remains one of the most popular Cosmetic Plastic Surgery procedures. Unlike weight loss, liposuction allows you to choose the areas where fat is removed. It is not a method of weight loss, or even weight maintenance, but it can remove those stubborn, disproportionate pockets of fat that just won’t leave despite a good diet and exercise.
Dr. Mele Discusses Liposuction on KRON 4’s Body Beautiful
The lastest television video segment from the Bay Area’s New Station, KRON 4’s Body Beautiful is included below. Liposuction is discussed, as well as the recovery.
Liposuction Video with Before and After Pictures
Before and After Pictures of Liposuction
Before and After Pictures of Liposuction are reviewed including:
Liposuction literally means fat suction. A cannula is placed under the skin via a small incision and fat is vacuumed out. The concept is simple, and maybe that’s why everyone thinks they can do it. There are many methods, but choosing the right Plastic Surgeon will always be more important than picking the “right” method. Just like a great musician playing Classroom Instruments will always sound better than an amateur playing a Stradivarius. Besides, fat is soft, so a bigger, hotter, stronger hammer is unnecessary, and is yet to be proven better.
A sculpture is defined by what remains, not the chips of marble left on the floor. Liposculpture is Liposuction, but emphasizes the importance of what is left behind rather than what is removed. The goal with Liposculpture is to create a better shape, not to remove as much fat as possible.
Additive Sculpture – Fat Transfer
Fat Transfer is currently a hot topic. It is probably best known as the Brazilian Butt Lift. A Brazilian Butt Lift is a procedure where fat is removed from an area that is disproportionate and is used for Fat Transplant to the Buttocks. The added volume not only enlarges the buttocks, but can reshape them too. The biggest limitations for fat transfer are the amount of fat available elsewhere in the body, and the nature of the buttocks’ skin.
Fat transfer is not as predictable as sculpture because fat is not as predictable as stone. The volume of fat transferred can change. Initially 50% to 100% of the fat may take. Obviously, this is a bigger problem if 50% takes on one side and 100% on the other. After the fat grafts have healed, they continue to behave like the area they where taken from. If you gain weight, the grafts will get bigger.
Another area that Plastic Surgeons are investigating is fat grafting to the breasts. Fat grafts are not as predictable as Breast Implants, and still are not ready for primetime when it comes to Breast Augmentation. However, after breast biopsies, lumpectomies or other traumatic changes to the breasts that effect breast contour, Fat Grafting to the Breasts can provide dramatic improvement.
Liposuction Consultations in the Bay Area
If you are considering Liposuction, and would like to schedule a private consulation appointment, call (925) 943-6353 today, or use the contact form in the margin. We are located in the San Francisco East Bay Area City of Walnut Creek, just over the Oakland/Berkeley Hills on 680 between San Ramon and Concord.
No matter who you choose, be certain to research your doctor. The following links, will make it easier. Just click on what you want to do:
Breast Augmentation remains the most popular Cosmetic Plastic Surgery. Whether restoring breast volume lost during pregnancy or weight loss, or enhancing the shape of small breasts, Breast Implants have provided a safe and effective method of Breast Enlargement for over 50 years.
Dr. Mele Discusses Breast Implants on Body Beautiful
This month, I discuss Breast Augmentation on KRON 4’sBody Beautiful. The show is broadcast live and reviews the latest plastic surgery news for the San Francisco Bay Area. In the video below, I discuss Breast Implants and Breast Augmentation. Before and After pictures of typical results are also reviewed, though edited for television, of course.
Breast Augmentation Video from this month’s Body Beautiful on KRON 4
Breast Augmentation Frequently Asked Questions
I cover as many Breast Augmentation Frequently Asked Questions as possible in this six minute and forty-nine second video. Some of the topics covered include:
Who is the ideal candidate for Breast Augmentation?
Can Breast Implants help with loose skin?
Do saggy breasts always require a Breast Lift?
What is the recovery period for Breast Enlargement?
Where is the scar placed for the Breast Implants?
Why are Silicone Breast Implants more often placed via the IMF incision (under the breast)?
What are the advantages of the Infra-Mammary Fold (IMF) Incision?
When can a Periareolar Incision (under the nipple/areola) be used?
What types of Breast Implants are currently available?
What is a Gummy Bear Breast Implant?
What is High-Strength, Highly Cohesive, Form-Stable silicone gel?
How to help your Plastic Surgeon pick the optimal Breast Implant Size?
Are Mommy Makeovers just for Mommies?
Multiple Breast Augmentation Before and After Pictures are discussed too.
Breast Augmentation Consultations
Type, Size and Method of Breast Augmentation are all important for a good result, but the most important variable is finding an experienced Board Certified Plastic Surgeon that you can talk to. Great Breast Enhancement is subjective, and it is as important for your Plastic Surgeon to understand your goals as it is for you to understand the benefits and risks of the procedure.
If you are considering Breast Augmentation, call (925) 943-6353 to schedule a private consultation with an experienced Breast Augmentation Specialist.
Mommy Makeovers exist because babies are hard on their mommy’s “B’s”: Breasts and Bellies. The physiological changes that are necessary for a healthy child are not always beneficial for a healthy mommy’s body.
How to Repair the Aftermath of Pregnancy
The television video segment below is from this month’s Body Beautiful. I discuss Mommy Makeovers, the alternative to living with the results of pregnancy for both the Breast and Belly, from the perspective of a Board Certified Plastic Surgeon who has taken care of many mommies.
For the Breasts, options include: Breast Augmentation, Breast Lifts, Breast Reduction or a combination of these. Reduction of hypertrophied (overly enlarged) nipples and areolae is also possible. For Bellies: Liposuction, Mini Tummy Tucks and most commonly, Full Tummy Tucks are available. The video provides an introduction to many of the options available, including fat grafting to the buttocks (Brazilian Butt Lift), but cannot substitute for an in depth consultation with an experienced and Board Certified Plastic Surgeon.
Mommy Makeover Video from this month’s Body Beautiful on KRON 4
Breast Enlargement for lactation is necessary, but when breasts shrink after breast feeding ends, the result can be empty, saggy breasts. Recent evidence points to pregnancy itself as the main culprit. Breast feeding, on the other hand, may instead offer benefits to both breast shape and baby wellness.
Why Breasts Sag With Pregnancy
Breasts are attached to the muscles behind them by long thin bands called Cooper’s Ligaments. When the breasts engorge, these ligaments elongate and cannot support the breasts as well. Immediately after breast feeding stops, the breast lose volume, which leads to further drooping. Some improvement occurs during the first six months after the cessation of lactation, so it is best to give the breasts a chance to recover, before planning your breast intervention.
There are many options for Breast Enhancement. The most common is Breast Augmentation, which restores lost volume and can help deflated breasts. When the breast enlargement that comes with pregnancy does not resolve, and the breast remain too large, Breast Reduction may provide relief from the excess weight and size of the breasts. If the size is good, but the breasts have dropped too low, a Breast Lift may be all that is needed.
What happens to the belly is a little simpler to understand. As the baby gets bigger, the belly stretches. This includes the skin and the muscle of the abdominal wall. Furthermore, the rectus muscles, which are a pair of muscles running down the middle of the belly, can separate and drift away from the midline causing abdominal weakness and diastasis.
What is Diastasis?
Diastasis is a separation of the rectus muscles. It is not a hernia and is usually not symptomatic or dangerous. A simple test for diastasis is to lay on your back, raise your shoulders off the bed/floor, and look at the center of your belly. Normally, when the shoulders rise the abdominal muscles tighten, and the abdomen flattens. With diastasis the mid-line, especially the area just above the belly button, will bulge upwards as the muscles tighten.
The bulge occurs because the muscles are no longer next to each other. As they are pulled apart with pregnancy, or weight gain, the middle of the abdominal wall is left unsupported. When the abdominal muscles tighten, the guts are squeezed and look for more room. The soft midline gives and provides additional space.
Repairing Diastasis is part of a Tummy Tuck, and one of the reasons that Abdominoplasty works better than diet and exercise for many mommies.
The most common abdominal component of the Mommy Makeover is the Tummy Tuck or Abdominoplasty. This provides repair of the muscle, tightening of the skin and removal of excess lower abdominal fat. If the problem is residual fat, and the skin is tight, Liposuction, alone may be all that is needed. When there is mild skin laxity isolated to the lower abdomen, a Mini Tummy Tuck could be a good compromise.
The Mommy Makeover has Lots of Options
Hopefully, the video and post above gives you some guidance. While information above is accurate, it may be specific to your needs, because every body is a little different, and individual needs and results will vary.
The best way to find out what the Mommy Makeover can do for you is during an in-person appointment with a Board Certified Plastic Surgeon. To schedule a private consultation, call my office at (925) 943-6353, and get the details you need to decide if the Mommy Makeover is the right procedure for you.