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General FAQ
Are the BodyAesthetic surgeons board certified?
Yes, all our surgeons have passed the difficult written and oral examination requirements to earn certification from the American Board of Plastic Surgery.
What are your office hours?
Our office stays open until 7:00 pm on Wednesdays, and opens at 7:00 am on Thursdays because we understand that not every patient can easily take time off work for a doctor's appointment.
On Mondays, Tuesdays, and Fridays, we are open from 8:00 am to 5:00 pm.
How does smoking affect my surgical result?
Smoking slows the healing process and increases the risks of developing complications after surgery. Surgeries that involve skin flaps (which includes all lifting procedures) are especially vulnerable to poor healing in smokers. In some people, smoking can contribute to the "death" of skin and tissue, called necrosis. In addition, the quicker the healing process, the less likely you are to develop unattractive scars.
Because of the higher rates of wound healing complications among smokers, we ask all our patients to stop smoking 3 to 4 weeks before surgery and remain tobacco free for 2 weeks afterwards. Some patients are tested for nicotine use before surgery. If they test positive, the procedure will be postponed.
When can I bathe, exercise, have sex, and return to work after surgery?
Every procedure is different, so the return to everyday activities varies. The procedure descriptions on this website briefly outline some postoperative restrictions and give a general sense of what can be expected after surgery, including when different types of activities can be resumed. More detailed information about restrictions will be provided by your surgeon during your consultation. The schedule for resuming your "normal" activities will partly depend on how you heal and how strong you feel. Follow-up appointments after surgery are important so your surgeon can evaluate your progress and advise you about specific activities.
Should I do special skin care before and after a facelift or other facial surgery?
Perhaps. The use of some skin care products, such as Retin-A, should be temporarily discontinued before and after most facial procedures, including skin resurfacing. After surgery, only very gentle cleansers and moisturizers should be used for a time specified by your surgeon or skin care specialist. The skin care regimen and products appropriate for your procedure will be explained during your consultation and follow-up appointments.
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What to Know Before Electing Surgery
The best way to find out what procedures might benefit you is to schedule a consultation with one of the surgeons at BodyAesthetic Plastic Surgery, all of whom have earned board certification from the American Board of Plastic Surgery. Every patient is unique, and cosmetic surgery is not a "one size fits all" discipline. Achieving the best aesthetic results from plastic surgery requires a surgeon who combines medical science, experience, and artistic vision.
Surgical Privileges and Facilities
The American Society of Plastic Surgeons recommends that people select a surgeon who has operating privileges at hospitals and outpatient facilities that have been credentialed in plastic surgery procedures. BodyAesthetic surgeons work at such facilities because we believe they offer extra protections for patient safety.
Even if your surgery is not performed in a hospital, your surgeon should have privileges to perform the same procedure in an accredited hospital. Some minimally-invasive procedures are done in our office (such as the ThreadLift, tissue filler injections, small volume liposuction, and many skin resurfacing procedures). For most surgeries, however, we prefer the added safety of a hospital and have privileges at Barnes-Jewish West County Hospital and Missouri Baptist Medical Center. We also operate at HealthSouth Ballas Outpatient Surgery Center, a fully accredited ambulatory surgery facility.
Fees and Insurance
Fees for cosmetic plastic surgery are paid prior to surgery. Because fees depend on the complexity of an operation, BodyAesthetic cannot quote specific prices over the phone, though we can provide a range. We have to meet with you to help you decide what procedure might be best for you.
You might think you're interested in a certain procedure but then find out that another procedure is more appropriate. If you want to have more than one procedure performed, it is less expensive to have both done during a single surgery because you'll then pay for the operating room and anesthesia only once.
We offer one piece of advice: Never choose a surgeon solely on the basis of price. You should entrust your face or body only to the plastic surgeon with whom you feel most comfortable. At BodyAesthetic, the initial consultation fee will be applied to your surgery cost should you decide to proceed, and follow-up visits to check on your progress have no charge.
As a rule, cosmetic plastic surgery is considered "elective" and therefore not covered by most insurance plans. Reconstructive surgery is generally covered by most health insurance policies, although coverage for specific procedures and levels of coverage can vary greatly.
There are many "gray areas" that require pre-certification as an insurance carrier decides whether your individual case is considered reconstructive or cosmetic. For example, eyelid surgery (blepharoplasty) might be covered if the eyelids are drooping severely and obscuring vision. If the weight of very large breasts causes pain or interferes with normal activities, a breast reduction might be considered reconstructive rather than cosmetic.
We work and argue with insurance carriers all the time and can give you a sense of whether the procedure you need might be covered by insurance.
Risks and Complications
Like all surgery, plastic surgery carries some uncertainty and risk, including the possibility of infection, bleeding, blood clots, adverse reactions to anesthesia, and other postoperative complications. These can occur no matter how skilled and experienced the surgeon.
You can reduce your risks by choosing a qualified surgeon and closely following his or her advice, both before and after surgery. The BodyAesthetic surgeons and staff take the time to fully inform each patient about the unexpected problems that could arise because we want our patients to be well-educated about these possibilities before surgery. Although complications are uncommon among our patients, they appreciate being informed about the possibilities in advance.
Your surgeon will check for medical conditions that could cause problems during or after surgery, such as uncontrolled high blood pressure, bleeding problems, or the tendency to form excessive scars. Be sure to tell your surgeon if you are taking any drugs, medications, or over-the-counter products, including herbs, since some of these can affect bleeding and bruising.
Because smoking increases the chances of developing a complication and slows the healing process, you will need to stop smoking two weeks before a surgical procedure and for four weeks afterwards.
Recovering From Your Surgery
For most cosmetic surgical procedures, normal activities should be restricted for a time following surgery. Your surgeon will explain the specific restrictions for your procedure, but the procedure descriptions on this website should provide a general idea of what to expect. It takes time for the visible signs of healing to subside. Plan your work and social activities to allow sufficient time for recovery.
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Breast Surgery
Surgery of the breasts is a major focus at BodyAesthetic Plastic Surgery. This is not surprising since Dr. Young is a nationally-recognized expert in breast augmentation, which is one of the most frequently-requested plastic surgery procedures. Breast reconstruction following mastectomy is another specialty of our surgeons. Women facing breast cancer should be aware that insurance companies are now mandated to cover breast reconstruction.
A breast lift, called mastopexy, is popular among women whose breasts have begun to sag after childbirth and nursing or as a result of aging and gravity. These women do not necessarily want larger breasts; they simply want to regain the more youthful position and contour of their breasts. We offer short-scar mastopexy, which produces two-thirds fewer scars than a traditional mastopexy. A breast lift can be combined with breast augmentation for women who want to get rid of breast sagging and also increase breast volume.
Breast reduction is increasingly popular among both men and women. Male breast reduction to treat a condition called gynecomastia can usually be done with liposuction. For women, removal of large amounts of breast tissue is required to treat the chronic back and neck pain associated with large breasts. In some cases, breast reduction may be covered by insurance policies for women who suffer pronounced physical symptoms due to their breast size. The surgeons at BodyAesthetic Plastic Surgery specialize in breast reduction that requires fewer scars than needed only a few years ago.
Our surgeons frequently treat breast implant complications in women who received implants for either augmentation or reconstruction. Complications may include a ruptured silicone gel implant or deflated saline-filled implant, capsular contracture, breast asymmetry, or malpositioned implants, among other problems. Treating implant complications can be much more difficult than performing a breast augmentation or reconstruction, so the surgeon you choose makes all the difference in your final result. Dr. Leroy Young is nationally regarded as an expert in dealing with breast implant complications.
Other breast procedures offered at BodyAesthetic include treatment of congenital deformities, ranging from Poland's syndrome (in which one breast is missing) to tuberous breasts (in which the lower portion of one or both breasts is constricted). Some breast deformities require use of a temporary tissue expander followed by a permanent implant and are similar to breast reconstruction. Girls with Poland's syndrome are diagnosed at a young age because of other chest deformities and often begin reconstruction of the absent breast in their teenage years, when the lack of a breast creates psychological discomfort around their peers.
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Breast Augmentation
Breast augmentation, technically known as augmentation mammoplasty, involves placement of an implant to enlarge and shape the breast. It is the second most popular cosmetic surgery operation in the U.S., performed on more than 330,000 women in 2004. (Only liposuction is more often requested.) In line with these national trends, breast augmentation is one of the more frequently performed procedures at BodyAesthetic Plastic Surgery.
The typical woman seeking augmentation is in her early thirties and has finished having children, though augmentation is popular among women ranging from the age of 18 to 50 and is even requested by women in their mid-60s. The reasons women seek breast augmentation are many, varied, and personal. Most are generally happy with their bodies but have been self-conscious for years about their small breast size, which they feel is out of proportion with the rest of their bodies. Because of the disproportion, they have difficulty finding clothes that fit.
An overriding motivation reported by women seeking augmentation is to feel better about themselves and gain greater self-confidence. Many women who have had and nursed children decide on breast augmentation as a way to regain the breast size and shape they had before becoming mothers. The best candidates for augmentation are healthy and well-adjusted women who want to get implants for themselves, not to please someone else. Breast implants can never fix a relationship or magically improve a life.
Breast augmentation involves inserting an implant behind each breast. Most women are looking for an increase of 1 or 2 bra cup sizes, but others want a greater size change. Before you decide to have augmentation surgery, you must think carefully about your expectations and what you hope to achieve. Then you must honestly discuss these goals with your surgeon so he can help you more clearly define what you want and whether breast augmentation is right for you.
Before You Choose Breast Augmentation
Breast implants do not last forever and will eventually break (rupture or deflate). Please see the Breast Implant Complications page for additional information on the types of problems most often seen with breast implants. Many of these complications will require another surgery, and women must be prepared for this possibility before getting an implant. During your consultation you will receive written materials that explain these complications in detail. Please ask your surgeon about anything you do not fully understand.
Decisions To Be Made With Your Surgeon
Our many years of experience have taught us that breast augmentation patients are much happier when they play an active role in planning their surgery. We will explain the many options available, such as the types and sizes of implants, where implants will be placed and through which incisions. In consultation with your surgeon, you will then decide which options you prefer.
Type of implant: All breast implants are made of a silicone shell that is filled with either silicone gel or saline (salt-water). Because of concerns about the safety of silicone gel breast implants, the Food and Drug Administration (FDA) decided several years ago that they should be available only to women who meet specific criteria and are willing to participate in approved studies. However, the implant manufacturers have since demonstrated the safety of these devices to the satisfaction of the FDA, and silicone gel implants will be made available to more women beginning in 2006. Saline-filled implants are currently obtainable by all breast augmentation patients on an unrestricted basis.
Your surgeon will explain what types of implants are available to you and answer any questions about their safety. He will also discuss the two types of implant surfaces (smooth and textured) and implant shapes (round and anatomical) to help you choose your preference.
Implant size: No one size of implant fits all women. In addition to the implant volume, implants have different diameters and heights. Your implant size will depend on a combination of your particular anatomy and the breast size you desire. Your surgeon will direct you to resources on the web that show photographs of real women (not models) before and after augmentation. You will be asked to find examples of women with a body shape like your own that illustrate what you want to look like after receiving breast implants. BodyAesthetic patients find this approach extremely helpful in deciding on breast size, and we insist that women take a very active role in discussing their surgery and goals.
Implant position: Breast implants can be placed either above or below the pectoralis major muscle, and each position has advantages and disadvantages. Your surgeon will explain what these are and help you decide on the position you prefer.
Incision location: Breast augmentation requires very small incisions that are usually inconspicuous. Your surgeon will discuss whether you prefer to have the incision located in the crease where the breast joins the chest (the inframammary crease), the areola, the armpit, or the belly button (umbilicus). The latter two incision locations require use of an endoscope for implant placement.
The Surgery
The method of inserting and positioning an implant will depend on your anatomy, your preferences, and your surgeon's recommendations. Working through a small incision for each breast, the tissue and skin are raised to create a pocket for the implant, either directly behind the breast tissue or beneath the large pectoralis major muscle on the chest wall. The implant is then centered beneath the nipple. After the opposite breast is done, the symmetry of both breasts is checked carefully and adjustments made if necessary. The incisions are then closed with stitches. The surgery usually takes about 1 hour if you are getting breast implants for the first time.
What To Expect After Breast Augmentation
You will probably feel tired and sore for a few days following surgery, but you'll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by medication prescribed by your doctor. Recovery takes longer when implants are placed beneath the muscle rather than on top of it because the muscle is raised, which is more painful than elevating only the breast tissue. Your breasts will be bruised, and you may feel a burning sensation in the nipples, but both should subside in a week or two. There will also be some breast swelling that may take 3 to 5 weeks to disappear completely. Stitches are absorbable so do not have to be removed.
You should be able to return to work within a week after surgery if your job does not demand a high level of activity. Most normal activities can be resumed within 1 or 2 weeks, but exercise should not begin until you are fully healed, usually 4 to 6 weeks. Your breasts will probably be sensitive to direct stimulation for 2 to 4 weeks, so physical contact should be avoided until the breasts are no longer sore.
Incision scars will be firm and pink for at least 6 weeks and may remain the same size for several months, or even appear to widen. After several months, your scars will begin to soften and fade. Although they will not disappear completely, they should be inconspicuous when fully healed.
A yearly breast examination by your surgeon is extremely important for all women with breast implants because he is much more experienced in detecting implant problems than any other type of physician. Regular mammograms for those 40 and older are also very important to look for problems with your implants, and special mammography views are needed.
Length Of Surgery
About 1 hour
Anesthesia
Usually general
In/Outpatient
Usually outpatient
Side Effects
Temporary soreness, swelling, change in nipple sensation, bruising. Breast sensitive to stimulation for a few weeks.
Risks
Lack of implant permanence--surgical removal or replacement of implants may be required to treat problems, including implant rupture or deflation, the formation of scar tissue around the implant (capsular contracture), bleeding, or infection. Increase or decrease in sensitivity of nipples or breast skin is occasionally permanent. Mammography requires a special technique.
Recovery
Back to work: usually within a week.
Physical contact with breasts: 3 to 4 weeks.
Fading of scars: several months to a year or more.
Duration of Results
Variable. Breast implants may require removal or replacement.
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Breast Reconstruction
Reconstruction of a breast that has been removed because of cancer or other disease is among plastic surgery's greatest achievements. New medical techniques and devices have made it possible for surgeons to create a breast that can come close in form and appearance to matching a natural breast, though it will never feel or look exactly like the breast that was lost.
The psychological difficulty of losing a breast to cancer may be so severe that breast reconstruction is now considered a medical necessity. Insurance policies are therefore mandated to pay not only for mastectomy but also for reconstruction of the lost breast and for surgical adjustments made to the opposite breast to achieve symmetry.
Breast reconstruction after a mastectomy is not a simple procedure and is usually done in stages. Patients have to consider many options and make several important decisions that will depend on individual circumstances, including other cancer treatments needed. The surgeons at BodyAesthetic will guide you through all the options as you explore what type of reconstruction is best for you.
Most mastectomy patients are medically appropriate for reconstruction, many at the same time that the breast is removed. The best candidates, however, are women whose cancer, as far as can be determined, seems to have been eliminated by mastectomy.
Patients frequently choose to begin reconstruction immediately following breast removal (mastectomy) so they awaken from surgery with a breast mound already in place and are spared the experience of waking up with no breast at all. In fact, women who postpone reconstruction may go through a period of emotional readjustment not unlike grief for a lost body part.
Still, there are legitimate reasons to wait. Many women aren't comfortable weighing all the reconstruction options while struggling to cope with a diagnosis of cancer. Others simply don't want to have any more surgery than is absolutely necessary. Some patients may be advised by their surgeons to wait, particularly if radiation treatment will be needed after mastectomy or the breast is being rebuilt in a more complicated procedure using flaps of skin and tissue transferred from another part of the body. Women with other surgical risks, such as obesity, high blood pressure, or smoking, may also be advised to wait. Regardless of the timing of reconstruction, being informed of the options before a mastectomy can help you prepare for cancer surgery with a more positive outlook for the future.
Reconstruction has no known effect on the recurrence of breast cancer, nor does it generally interfere with chemotherapy or radiation treatment, should cancer recur.
Women can begin talking about reconstruction as soon as they are diagnosed with cancer. The surgeons at BodyAesthetic Plastic Surgery prefer to work together with your breast surgeon before mastectomy to develop a strategy that will put you in the best possible condition (physical and emotional) for breast reconstruction.
After evaluating your health, your surgeon will explain which reconstructive options are most appropriate for your age, health, anatomy, tissues, and goals. Be sure to discuss your expectations frankly with your surgeon, and he will be equally frank when describing your options and the risks and limitations of each.
Reconstruction Options
Breast reconstruction usually involves more than one operation. The first stage begins creation of a breast mound to replace the breast tissue removed in a mastectomy. This stage is performed either at the same time as the mastectomy or delayed until later.
Reconstruction with a breast implant: The most common way to construct a breast mound is to use an implant. However, because some skin is removed during mastectomy in addition to tissue, there is usually not enough skin and tissue to cover and support an implant large enough to recreate a breast. This problem is solved by first inserting a tissue expander beneath the chest muscle.
This balloon-like expander has a tiny valve mechanism buried beneath the skin through which saline (salt-water) is injected on a regular basis by your plastic surgeon. Expansion, which is done in the office, takes only a few minutes as 50 to 100 cc (2 or 3 ounces) of saline are added weekly to gradually stretch the tissues over several weeks or months. When the tissues have been sufficiently stretched, a second surgery is done to remove the tissue expander and replace it with a more permanent breast implant.
Women who undergo breast reconstruction may receive implants filled with either silicone gel or saline. When the FDA restricted the availability of silicone gel implants in 1992, it made an exception for breast reconstruction patients, for whom getting an implant is not considered elective. In addition, silicone gel implants look and feel more natural than saline implants, especially when no breast tissue exists to pad the implant.
Reconstruction with a tissue flap:
An alternative approach to breast reconstruction involves transferring a flap of tissue taken from another part of the body, such as the back, abdomen, or buttocks. This complicated surgical procedure takes several hours in the operating room followed by a lengthy recovery period. Not everyone is a candidate for flap reconstruction, but those who choose this option are very pleased with the results because it produces the most realistic-looking breast mound, which is reconstructed entirely with your own tissue rather than an implant. Flap reconstruction leaves a scar at the tissue donor site in addition to the scar on the breast.
In one type of flap surgery, the tissue remains attached to its original blood supply, or its vascular pedicle. The flap--which consists of skin, fat, muscle and blood vessel--is tunneled beneath the skin to the chest and "molded" to create the breast mound or, in some cases, a pocket for an implant. The flaps most often used involve transfer of a muscle from the abdomen (called a transverse rectus abdominis muscle flap, or TRAM) or from the back (called a latissimus dorsi flap).
Transfer of a TRAM flap takes 4 to 6 hours and requires hospitalization for 3 to 5 days. Activity is restricted for 4 to 6 weeks. A TRAM flap leaves a permanent scar on the abdomen and may cause weakness of the abdominal wall.
Transfer of a latissimus flap takes 3 to 4 hours, followed by 2 to 3 days in the hospital. Activities may be resumed in 3 to 4 weeks. The latissimus muscle does not have as much tissue for transfer as a TRAM flap. Because of this, insertion of a breast implant is needed by some patients to add volume to the reconstruction. The scar produced by a latissimus flap starts below the armpit and curves downward toward the middle of the back.
Another flap technique uses tissue that is surgically removed from the abdomen, thighs, or buttocks and transplanted to the chest, where the flap's blood vessels are connected to a blood supply source in the chest. This procedure takes even longer than a regular flap because it involves intricate microvascular surgery to reconnect the flap's blood supply.
Reconstruction of the nipple and areola: The nipple and areola (the darker skin surrounding the nipple) can be reconstructed in the final stage of breast reconstruction. Some women are content just with reconstruction of the breast mound and do not undergo this final stage, but many others choose this option because it makes the reconstructed breast look more normal.
Reconstruction of a structure that looks like a nipple requires a short surgery, usually under local anesthesia, that rotates a small amount of tissue from the center of the breast mound to form a nipple-like structure. The best way to recreate the areola is with tattooing done by someone we will recommend who specializes in this type of tattoo and can match the color of the areola on the opposite breast.
Surgery on the opposite breast:
A reconstructed breast will almost never match the size and contour of the remaining opposite breast. Many women therefore choose to have surgery on the opposite breast to achieve better symmetry. This may involve enlarging, reducing, or lifting the natural breast to match the reconstructed breast, with the procedure usually done at the same time that a tissue expander is replaced with a permanent implant. For patients undergoing reconstruction with a tissue flap, the opposite breast is typically revised in a later surgery.
Before You Choose Reconstruction With An Implant
Breast implants do not last forever and will eventually break (rupture or deflate). Please see the Breast Implant Complications page for additional information on the types of problems most often seen with breast implants. Many of these complications will require another surgery, and women must be prepared for this possibility before getting an implant. During your consultation you will receive written materials that explain these complications in detail. Please ask your surgeon about anything you do not fully understand.
The Surgery
Because breast reconstruction has so many options, no brief description can encompass all possibilities. Your surgical procedure will depend on whether you begin the reconstructive process at the time of mastectomy or delay it until later. Surgery differs if reconstruction is done with a tissue expander followed by an implant or with your own tissue transferred to the breast. Your surgeon will explain all these options, help you decide what works best for you, and explain the surgery in detail. Please ask about anything you don't understand.
What To Expect After Breast Reconstruction
You are likely to feel tired and sore for a week or two after reconstruction, but most of your discomfort can be controlled with medication prescribed by your doctor. We prefer to do the first stage of breast reconstruction as an inpatient procedure, which means you will stay in the hospital for at least one night after surgery. If a mastectomy is done at the same time, a second day/night in the hospital may be needed. If your reconstruction is done with a tissue flap, the hospital stay may last as long as 5 days to guarantee that blood supply to the transferred flap is robust.
Many first-stage reconstruction options require a surgical drain to remove excess fluids from the surgical area immediately following the operation, but these are removed within 1 or 2 weeks after surgery. Most stitches are removed in 7 to 10 days.
Removal of a tissue expander and replacement with a permanent implant can be done on an outpatient basis, though some women prefer to spend 1 night in the hospital after surgery.
Recovery from a combined mastectomy and reconstruction may take up to 6 weeks, and much of the recovery time will depend on the type of mastectomy and whether lymph nodes are removed from the armpit area. If the first stage of breast reconstruction is delayed until after you have healed from a mastectomy or completed cancer treatments, your recovery time should be relatively short if you receive a tissue expander. Recovery from a tissue flap reconstruction takes up to 6 weeks.
Reconstruction cannot restore normal sensation to your breast, but in time, some feeling may return to your skin. The scars resulting from mastectomy and reconstruction will never disappear entirely but most scars will fade substantially over time, though it may take as long as 1 to 2 years.
Your surgeon will advise you about when to begin stretching exercises and normal activities. As a general rule, you should refrain from any overhead lifting, strenuous sports, and sexual activity for 3 to 6 weeks following reconstruction.
A reconstructed breast is likely to feel firmer and look rounder or flatter than a natural breast. It may not have the same contour as the breast before mastectomy, nor will it exactly match the opposite breast. But these differences will be apparent only to you. For most mastectomy patients, breast reconstruction dramatically improves the quality of life and appearance following cancer surgery.
SUMMARY COMPARISON OF RECONSTRUCTION OPTIONS
Surgery Time
Expander/Implant: 1 to 2 hours
Latissimus Flap: 3 to 4 hours
TRAM Flap: 4 to 6 hours
Hospital Stay
Expander/Implant: 1 day
Latissimus Flap: 2 to 3 days
TRAM Flap: 3 to 5 days
Blood Transfusion Needed
Expander/Implant: Unlikely
Latissimus Flap: Unlikely
TRAM Flap: Possible
Resume Activity
Expander/Implant: 2 to 3 weeks
Latissimus Flap: 3 to 4 weeks
TRAM Flap: 4 to 6 weeks
Implant Needed?
Expander/Implant: Yes
Latissimus Flap: Maybe
TRAM Flap: No
Incision
Expander/Implant: No additional incision
Latissimus Flap: Incision on back
TRAM Flap: Incision on abdomen
Other
Expander/Implant: No loss of muscle strength
Latissimus Flap: May have shoulder weakness from tissue transfer
TRAM Flap: May have abdominal weakness from tissue transfer
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Breast Lift (Mastopexy)
Over time, pregnancy, nursing, aging, the force of gravity, and weight loss all take their toll on a woman's breasts. As the skin loses its elasticity, the breasts often lose their shape and firmness and begin to sag. A breast lift, or mastopexy, is a surgical procedure that raises and reshapes sagging breasts, at least for a time. (No surgery can permanently delay the effects of gravity.) Mastopexy can also reduce the size of the areola, the darker skin surrounding the nipple.
Women considering mastopexy must be realistic about what the surgery can accomplish. Results are usually superior in women with smaller, sagging breasts. Although breasts of any size can be lifted, the lifting effect may not last as long in heavy breasts. For women with large and heavy breasts, a breast reduction is usually more appropriate. Both procedures have many similarities, but breast reduction removes some of the breast tissue, in contrast to a mastopexy that removes skin only and reshapes the breast. In both surgeries, the nipples and areolas are raised to a higher position on the breast mounds to produce a more youthful contour.
Many women seek mastopexy because pregnancy and nursing have left them with stretched skin and less volume in their breasts. Women planning to have more children should probably postpone a breast lift because a future pregnancy is likely to stretch the breasts again. If you do become pregnant after a breast lift, you should still be able to breastfeed since the milk ducts remain attached to the nipples.
The biggest disadvantage of a mastopexy is that it leaves permanent scars, which may be quite noticeable in some women, though they will be covered by a bra or bathing suit. (Poor healing and wider scars are more common in smokers.) The surgeons at BodyAesthetic Plastic Surgery are experienced in short-scar mastopexy techniques, which require fewer and smaller incisions, and therefore produce fewer scars than traditional mastopexy methods. We only rarely need to use this older mastopexy technique anymore.
During the consultation, your surgeon will determine whether you are a good candidate for a short-scar procedure. The mastopexy technique that is best for you will depend on the size and shape of your breasts, the size of your areolas, and the extent of the sagging and excess skin.
Women who have breasts that are both small and sagging may get the best results if the mastopexy is combined with breast implants. For many women, mastopexy plus augmentation produces better results when done as two procedures, with the mastopexy performed first followed by augmentation a few months later. If this is a possibility, your surgeon will thoroughly discuss breast implants and the timing of surgery so you can make a fully informed decision.
The Surgery
Mastopexy usually takes 1 to 3 hours. Surgical techniques vary depending on your anatomy and preferences, but the most common procedure used by BodyAesthetic surgeons involves removing excess skin through an incision made around the areola and extended vertically between the areola and the inframammary crease (the natural fold below the breast). The incision around the areola is needed so the nipple and areola can be raised to a higher position. When appropriate, the areola, which tends to enlarge in diameter with age and pregnancy, can be made smaller.
After excess skin is removed around the incision, the skin that remains is re-draped over the breast tissue to create a natural breast contour. The resulting scar is shaped like a lollipop, around the areola and straight down to the inframammary crease. If there is a large excess of skin, another incision that runs horizontally along the inframammary crease may be needed, but this is rarely required for a mastopexy.
Some patients, especially those with relatively small breasts and minimal sagging, may be candidates for a modified procedure that requires only a circular incision made around the areola. This is called a "doughnut" (or concentric circle) mastopexy, because excess skin is removed only from this doughnut-shaped area. Most women who seek mastopexy have more excess skin than can be removed through this circular incision.
What To Expect After A Breast Lift
After surgery, your breasts will be bruised, swollen, and uncomfortable for a few days, but the pain shouldn't be severe and can be relieved with medications prescribed by your surgeon. The breasts are bandaged at first, but the bandage is replaced within a few days by a soft sports bra that provides support. It should be worn over a layer of gauze 24 hours a day for 3 to 4 weeks. The stitches are absorbable and don't have to be removed.
You should expect some loss of feeling in the nipples and breast skin, which is caused by swelling after surgery. This numbness usually fades as the swelling subsides over the next 6 weeks or so. In some patients, however, numbness may last a year or more. Rarely, it may be permanent.
You should be up and about in a day or two after surgery, but don't plan on returning to work for a week or more, depending on how you feel. And avoid lifting anything over your head for 3 to 4 weeks. Your surgeon will give you detailed instructions for gradually resuming your normal activities.
Even though your surgeon will make every effort to make your scars as inconspicuous as possible, mastopexy scars are permanent and will not be invisible. They may remain lumpy and red for months, then gradually become less obvious, perhaps eventually fading to thin white lines. Fortunately, the scars are located on the lower part of the breast and will not be visible to others even if you wear low-cut tops.
The results of a breast lift will not last forever, and the effects of gravity, aging, and weight fluctuations will eventually take their toll again. Women who get implants along with a mastopexy usually find that the results last longer.
Length Of Surgery
1 to 3 hours
Anesthesia
Usually general
In/Outpatient
Usually outpatient, sometimes inpatient
Side Effects
Temporary bruising, swelling, discomfort, numbness, and/or dry breast skin. Permanent scars.
Risks
Thick, wide scars; skin loss; infection. Unevenly positioned nipples. Permanent loss of feeling in nipples or breast skin.
Recovery
Back to work: 1 week or more.
Strenuous activities: 1 month.
Fading of scars: several months to a year.
Duration of Results
Variable; gravity, pregnancy, aging, and weight changes may cause new sagging. Results may last longer or be enhanced when breast implants are inserted.
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Breast Reduction
Women with very large, heavy and drooping breasts may experience a variety of medical problems caused by their excessive breast weight. Symptoms typically include back, shoulder and neck pain, skin irritation and rashes beneath the breasts, stooped posture, permanent shoulder indentations caused by bra straps, and sometimes breathing difficulties. Physical activity may be restricted by the size and weight of the breasts. In addition to such physical problems, unusually large breasts can make women, or teenage girls, feel extremely self-conscious and embarrassed. Finding clothes that fit is another worry.
Breast reduction, technically known as reduction mammoplasty, removes fat, glandular tissue, and skin from the breasts to make them smaller, lighter, and firmer. When needed, the surgery also reduces the size of the areola (the darker skin surrounding the nipple). The goal is to create smaller, well-shaped breasts that are in better proportion to the rest of the body.
Breast reduction is usually performed to relieve physical, and often emotional, discomfort rather than simply to improve cosmetic appearance. Because of this, some health insurance policies will cover the surgery costs. The staff at BodyAesthetic Plastic Surgery will help determine if surgery might be covered by insurance.
In most cases, breast reduction is performed after the breasts are fully developed, but it can be done earlier if large breasts are causing serious physical discomfort and/or psychological difficulties for teenagers. The best candidates for reduction are those who are mature enough to fully understand the procedure and have realistic expectations about the results. Breast reduction is usually not recommended for women who intend to breastfeed in the future because the surgery removes some of the glandular breast tissue, which can decrease milk production.
Breast reduction is not a simple operation, but it is safely performed by trained plastic surgeons. The procedure does leave noticeable and permanent scars, though they will be covered by a bra or bathing suit. (Poor healing and wider scars are more common in smokers and dark-skinned individuals.) The procedure can also produce breasts that are slightly asymmetrical or unevenly positioned nipples. However, most women with very large breasts are not symmetrical to begin with.
Some patients may experience a permanent loss of feeling in their nipples or breasts. In a very small percentage of women, the nipple and areola may lose their blood supply and the tissue will die. In such rare cases, the nipple and areola can be reconstructed with skin grafts taken from elsewhere on the body.
The Surgery
Breast reduction surgery is performed in the hospital on either an outpatient or inpatient basis, depending on whether you need to stay overnight in the hospital after surgery. The length of the procedure is determined by the technique used and amount of tissue removed but usually takes 2 to 4 hours.
Techniques for breast reduction vary and depend on the size of the breasts and the degree of reduction the patient wants. The procedure we use most often includes an incision that circles the areola and then extends downward vertically to the inframammary crease (the natural fold below the breast). This short-scar breast reduction leaves a scar shaped like a lollipop. If the breasts are very large, another incision that runs horizontally along the inframammary crease may be needed. This traditional reduction mammoplasty scar is shaped much like a boat anchor.
After the excess glandular tissue, fat, and skin are removed, the nipple and areola are moved into their new, higher position. The remaining skin and tissue are then draped around the areola until a pleasing breast shape and contour are achieved. Liposuction is sometimes used to remove excess fat from the area near the armpit.
In most cases, the nipples remain attached to their blood vessels and nerves. However, if the breasts are very large or pendulous, the nipples and areolas may have to be completely removed and grafted into a higher position. This will result in a loss of sensation in the nipple and areolar tissue, and breastfeeding will be impossible.
What To Expect After Breast Reduction
After surgery, the breasts are wrapped in an elastic bandage or a surgical bra placed over gauze dressings. This dressing is usually removed 4 to 5 days after surgery and replaced with a soft sports bra that provides support and is worn 24 hours a day for several weeks, until the swelling and bruising subside. Most stitches are absorbable and do not have to be removed.
You will feel some pain for the first few days, especially when you move around or cough, and some discomfort will remain for a week or more. Your surgeon will prescribe medication to lessen the pain.
Your first menstrual period following breast reduction may cause your breasts to swell and hurt. You may also experience random, shooting pains for a few months.
If the nipples and areolas can be repositioned with their nerves intact, you will have some loss of feeling in the nipples and breast skin caused by the swelling after surgery, but this usually fades over the next 6 weeks or so. In some patients, however, the sensory loss may last a year or more; rarely, the loss of sensation is permanent. Nipple sensation is lost completely if the nipples and areolas must be removed completely and re-grafted into a higher position.
Your surgeon will give you detailed instructions for resuming your normal activities, but you should be up and moving around your house within a day or two after surgery. Most women can return to work (if it's not too strenuous) and social activities in 1 or 2 weeks, though the breasts may continue to ache occasionally for a couple of weeks. You should expect to have much less stamina for several weeks and limit exercise to stretching, bending, and swimming until your energy level returns. Also, avoid lifting or pushing anything heavy for 3 or 4 weeks.
You may be instructed to avoid sex for a week or more, since sexual arousal can cause your incisions to swell. Anything other than gentle contact with your breasts should be avoided for about 6 weeks.
A small amount of fluid draining from your incisions is normal, as is some crusting around the incisions. If you have any unusual symptoms, such as bleeding or severe pain, call your surgeon right away.
Although much of the swelling and bruising will disappear in the first few weeks, it may be 6 months to a year before the breasts settle into their final shape. Even then, their shape may fluctuate in response to hormonal shifts, weight changes, or pregnancy.
Your surgeon will try hard to make your scars as inconspicuous as possible, but breast reduction leaves extensive and permanent scars. They often remain lumpy and red for months, then gradually become less obvious and may eventually fade to thin white lines. Fortunately, the scars are not visible when a bra or low-cut top is worn. Almost all breast reduction patients are more than willing to accept the scars in exchange for having normal-sized breasts.
Of all plastic surgery procedures, breast reduction produces the quickest body-image changes. Almost immediately after surgery you will notice that the physical discomfort of large breasts is gone, your body will look better proportioned, and clothes will fit better. Even so, some patients are quite shocked at first by the smaller breast size. It may take a little time to adjust to your new body so be patient and remember why you wanted the surgery in the first place.
Length Of Surgery
2 to 4 hours
Anesthesia
Usually general
In/Outpatient
Usually outpatient for smaller breasts and short-scar procedures. One night in the hospital is typical for very large breasts that require a traditional breast reduction with its additional incisions.
Side Effects
Pain for a few days. Soreness, swelling and bruising for a few weeks. Some loss of nipple and breast skin sensation until the swelling subsides. Breast sensitive to stimulation for up to 6 weeks.
Risks
Permanent scars that are not visible when wearing a bra but may be unattractive in the nude. Wide and/or red scars. Bleeding or infection. Decrease in sensitivity of nipples or breast skin, occasionally permanent. In rare cases, loss of nipple and areola if blood supply is not vigorous.
Recovery
Back to work: usually within 1 to 2 weeks.
Physical contact with breasts: about 6 weeks.
Fading of scars: several months to a year or more.
Settling of the breasts to their final shape: 6 months to a year.
Duration of Results
Permanent unless you gain a lot of weight. Some breast sagging will occur as you age.
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Body Contouring
Cosmetic surgery can re-contour just about every area of the body. For example, liposuction, which removes excess fat deposits, can be performed on the neck, upper arms, waist, abdomen, hips, flanks, buttocks, thighs, knees, calves, and ankles. Liposuction is increasingly requested by men who cannot get rid of "love handles" no matter how much they exercise. For many women, no amount of sit-ups will flatten the abdomen after childbirth. In these cases, liposuction combined with a "tummy tuck" (either a standard or mini-abdominoplasty) usually solve the problem.
Body contouring does not always involve fat removal. Some patients have sagging or excess skin that needs to be removed. Skin sagging is typically caused by aging , while skin excess may result after a major weight loss or liposuction. Re-contouring lifts of the arms (brachioplasty), breasts, upper body (torsoplasty), thighs, buttocks, or entire lower body (called a circumferential body lift) are specialties of BodyAesthetic surgeons. The art of plastic surgery plays a major role in all body contouring procedures because the surgeon basically sculpts the body into a pleasing contour.
Most women have some degree of cellulite by the time they are 35, even those who are not overweight. As we age, gravity disrupts the tight bonds between skin and its underlying supportive tissues, and fat cells grow into the lower layers of the skin. This process creates the dimpled appearance known as cellulite. In women of normal weight, cellulite can worsen because of skin and tissue laxity. A lifting procedure, such as a tummy tuck, thigh lift, or circumferential body lift, is the most effective way to treat cellulite caused by skin and tissue laxity.
Our surgeons are nationally-regarded as experts in body contouring of massive weight loss patients who have undergone gastric bypass surgery or lost weight through vigorous diet and exercise programs. Losing a very large amount of weight often leaves patients with an excess of skin and tissue that may hang in loose folds in multiple areas of the body. This can be very uncomfortable, create problems with hygiene, and make it difficult to find clothing that fits. The BodyAesthetic surgeons are on the leading edge of this new field in plastic surgery and teach their innovative techniques to other surgeons around the country.
BodyAesthetic Plastic Surgery offers gluteal augmentation that can be done with implants, with injections of fat transferred from another area of the body, or with a flap of tissue from the gluteal area that is contoured to create a more rounded projection of the buttocks. Enhancing the gluteal region is often incorporated into a lower body lift but can be performed alone.
The body contouring you think you want may not be what is most appropriate for you. For example, a patient may think she needs a tummy tuck or thigh lift when liposuction will accomplish the same thing with less scaring. The reverse can also be true; a patient may want liposuction but achieve better results with a tummy tuck. Your surgeon will determine whether excess fat or excess skin is your primary problem and explain the various options available to achieve the results you want.
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Liposuction
The surgeons of BodyAesthetic Plastic Surgery & Skin Care Center are St. Louis plastic surgery specialists who assist liposuction patients achieve a smoother, sleeker figure. In the paragraphs below, the liposuction procedure is described. To view the results achieved by St. Louis liposuction patients, please scroll down to view before and after photos.
Liposuction sculpts the body by removing unwanted deposits of fat and can be done on nearly any area of the body, including the abdomen, hips, flanks, back, buttocks, thighs, knees, ankles, upper arms, chin, cheeks and neck. It is the most popular plastic surgery procedure in the U.S., performed on nearly half a million Americans in 2004. Increasingly requested by both men and women, liposuction is ideal for getting rid of localized areas of fat that will not go away no matter what you do.
During the past decade, liposuction (also known as "lipoplasty" or "suction lipectomy") has benefited from several new refinements and techniques that produce more precise results and quicker recovery times. Although liposuction is not a substitute for losing weight, it can remove stubborn areas of fat that don't respond to traditional dieting or exercise.
Liposuction Candidates
The best candidates for liposuction are people of normal weight with firm, elastic skin who have pockets of excess fat in certain areas. They should be physically healthy, psychologically stable and have realistic expectations. Although age is not a major consideration, older patients tend to have skin that is less elastic and therefore may not get the same results as a younger patient with tighter skin.
Liposuction carries greater risk for individuals with medical problems such as diabetes, obesity, significant heart or lung disease, poor blood circulation, tobacco use, or those who have recently had surgery near the area to be contoured. Your surgeon will determine whether special precautions need to be taken for liposuction to be safe for you.
In your initial consultation, your surgeon will evaluate your health, determine where your fat deposits lie, assess the condition of your skin, and explain the body contouring method most appropriate for you. Be honest in discussing your expectations with your surgeon, and he will be equally frank when explaining the risks and limitations of liposuction.
Liposuction : The Surgery
Liposuction is performed through small incisions, less than a half-inch in length, that are made in an inconspicuous location near the area to be treated. The first step is to inject (infuse) a specified amount of fluids that is roughly equal to the amount of fat to be removed. This fluid consists of saline (salt-water) solution that contains epinephrine. The saline plumps up the fatty tissue, and the epinephrine constricts the blood vessels to minimize bleeding.
A slim hollow tube, called a cannula, is inserted through the incision and moved back and forth through the tissue to break up the fat cells, which are then suctioned out, along with the infused fluids. If multiple body areas are treated, your surgeon moves from one area to the next repeating the steps of infusing fluids, breaking up the fatty tissue, and sucking it out.
The preceding paragraph briefly describes what is called suction-assisted lipoplasty (SAL), which is the standard type of liposuction used by BodyAesthetic surgeons. In certain situations, our surgeons also may use ultrasound-assisted lipoplasty (UAL), which has a special cannula that produces ultrasonic energy. This ultrasonic energy explodes the walls of fat cells to liquefy the fat, which is then suctioned out. UAL improves the effectiveness of liposuction in fibrous areas of the body, such as the upper back or the male abdomen, and is also effective for patients undergoing a second liposuction in an area previously treated.
In general, UAL takes longer to perform than SAL. The time required to perform liposuction varies considerably, depending on the number and sizes of areas being treated. As the surgeon works, he basically sculpts the body contour with differently-sized cannulas and pays special attention to making sure both sides of the body are as symmetrical as possible.
Because fluids are infused into the tissues and then suctioned out with the fat, careful monitoring of patients' fluid levels is essential to make sure their fluid balance remains within safe limits. Being overloaded with fluids or having fluid volume depleted can both lead to serious complications if fluids are not managed properly. Most patients need to receive intravenous fluids during and immediately after surgery.
The scars from liposuction are small and strategically placed to be hidden from view. However, imperfections in the final appearance are not uncommon after lipoplasty. The skin surface may be irregular or contain dented areas, symmetry may not be perfect, or the skin may not contract sufficiently to conform to the new body contour, especially in older patients. Numbness or pigmentation changes in treated areas also can occur. Sometimes, additional surgery is recommended to refine results.
What To Expect After Liposuction
Some swelling and bruising will follow liposuction, and small amounts of fluids may drain from the small incisions. To help control swelling and fluid collection, patients who have liposuction of the legs are usually fitted with a snug elastic garment to wear over the treated area for a few weeks.
Don't expect to look or feel great right after surgery. Even though the newer techniques are believed to reduce postoperative discomfort, some pain, burning, swelling, bleeding, and temporary numbness should be expected. Pain can be controlled with medications prescribed by your surgeon, but you may still feel stiff and sore for a few days.
Some liposuction patients may feel a bit anxious or depressed in the days or weeks immediately following surgery because they are uncomfortable and unable to see what they will ultimately look like. However, this feeling subsides as they begin to look and feel better.
Healing is a gradual process. You should start walking around as soon as possible to reduce swelling and help prevent blood clots from forming in your legs. Although you may be able to return to work within a few days of surgery, you will still be swollen and sore for a week or more. Your return to work likely depends on how many areas of the body are treated with liposuction. If you received stitches to close the small incisions, they will be removed 7 to 10 days after surgery.
Strenuous activity should be avoided for about a month as your body continues to heal. Although your new body contour will probably not be visible at first, most of the bruising and swelling usually disappear within 3 weeks and a noticeable change should be apparent within 4 to 6 weeks after surgery as swelling continues to subside. However, your final body contour may not emerge for up to 6 months or more.
Those who have realistic expectations before surgery are very pleased with the results of liposuction. They feel more comfortable in a wider variety of clothing and more at ease with their body contour. Eating a healthy diet and getting regular exercise can help maintain this new shape.
Length Of Surgery
1 to 3 hours or more, depending on the number of areas treated
Anesthesia
Usually general
In/Outpatient
Usually outpatient. Extensive procedures may require short inpatient stay. It depends on the number of liters of fat removed; for example, if more than 5 liters are removed, you'll spend 1 night in the hospital.
Liposuction : The Side Effects
Temporary bruising, swelling, numbness, soreness, burning sensation.
Liposuction : The Risks
Asymmetry. Rippling or bagginess of skin. Pigmentation changes. Skin injury. Fluid retention. Excessive fluid loss leading to shock. Infection. UAL: thermal burn injury caused by heat from the ultrasound device.
Liposuction : The Recovery
Back to work: 1 to 2 weeks.
More strenuous activity: 2 to 4 weeks.
Full recovery from swelling and bruising: 1 to 6 months or more.
Duration of Results
Permanent unless you gain weight
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Tummy Tuck
St. Louis tummy tuck patients seek treatment at BodyAesthetic Plastic Surgery & Skin Care Center for assistance in tightening and toning their abdomens. The surgeons of BodyAesthetic treat these patients in their renowned St. Louis plastic surgery clinic. To learn more about the tummy tuck (abdominoplasty) procedure, please read the detailed paragraphs below.
Everyone would like to have a flat, tight tummy. As we age, that goal may not be achievable, no matter how much we exercise or how much weight we lose. People of normal body weight and proportion can still develop an abdomen that protrudes or is loose and sagging. This tummy "pooch" that just will not go away has many causes, including heredity, pregnancies, prior abdominal surgery, major weight loss, or back problems that affect posture. In addition, our abdominal muscles usually lose tone as we age.
For those who want a tighter, flatter abdomen, a "tummy tuck" (abdominoplasty) may be the answer. An abdominoplasty removes excess skin and fat from the middle and lower abdomen and, in some cases, tightens the muscles of the abdominal wall that have become weakened, stretched, or separated (as happens with pregnancy, for example). The procedure creates an abdominal contour that is smoother, flatter, and firmer.
The surgeons at BodyAesthetic Plastic Surgery perform different types of tummy tucks, ranging from a full abdominoplasty to a mini-abdominoplasty. Your surgeon will explain the tummy tuck options available and determine which procedure best suits your goals and the anatomy of your abdomen (how much excess fat, tissue, and skin you have and where it is located). Be honest about your expectations and goals during the consultation so your surgeon can design the treatment that's best for you.
Abdominoplasty can be performed on adults of any age who are in good health, close to their ideal weight, and moderately fit. But patients must understand that abdominoplasty is a major surgery that produces a permanent scar, which may extend from hip to hip, depending on the extent of the original problem and the surgery required to correct it. Most of the scar is usually located just above the pubic bone.
Abdominoplasty is most effective in correcting problems below the navel, but some tissue can be removed above the navel, usually through the same incision placed low on the abdomen. Sometimes, excess fat above the navel is best removed with liposuction, which may be done in the same surgery or in a later procedure.
Although the results of an abdominoplasty are considered permanent, weight fluctuations after surgery can cause the abdomen to protrude again. Patients who intend to lose a lot of weight should postpone the surgery until they have reached their weight goals. Also, women who plan future pregnancies should wait until they are finished having children so the results of an abdominoplasty are not undone.
People who have had previous abdominal surgery may find that these scars are more prominent because abdominoplasty tightens and stretches the skin. However, a pre-existing horizontal scar on the lower abdomen can often be removed during an abdominoplasty.
Tummy Tuck (Abdominoplasty) : The Surgery
Abdominoplasty is usually performed under general anesthesia. A full abdominoplasty takes 2 to 4 hours, depending on the extent of work required. A mini-abdominoplasty takes 1 to 2 hours. These two procedures, described below, are basically the two extremes, and variations between these extremes are possible. Your abdominoplasty surgery will depend on how much correction of the abdominal contour is desired and practical.
In a full abdominoplasty, the surgeon makes an incision from hipbone to hipbone, just above the pubic area. A second incision is made to free the navel from its surrounding tissue. The surgeon then separates the skin from the abdominal wall all the way up to the ribs and lifts the skin flap to reveal the vertical muscles in the abdomen. These muscles are tightened by pulling them close together and stitching them into their new position. This provides a firmer abdominal wall and narrows the waistline.
The skin flap is then pulled and stretched downward toward the pubic area, the extra skin is removed, and the skin above and below the incision is stitched together with absorbable sutures (which do not need to be removed). A new opening is cut for the navel, which is then stitched in place. Incisions are sealed with DermaBond (the medical equivalent of superglue) to keep the wound clean, dry, and secure.
For a mini-abdominoplasty, the incision is much shorter and the navel may not be moved. The skin is separated from the underlying tissue only between the incision line and the navel. This skin flap is stretched downward, the excess is removed, and the skin above and below the incision is stitched together and secured.
What To Expect After A Tummy Tuck
There are always risks associated with surgery and specific complications associated with abdominoplasty. Postoperative complications such as infection and blood clots are rare but can occur. Infection can be treated with drainage and antibiotics but will prolong your hospital stay. You can minimize the risk of blood clots by moving around as soon as possible after the surgery.
Poor healing, which results in conspicuous scars, may necessitate a second operation. Because smoking can increase the risk of complications and delay healing, smokers should stop at least 2 weeks before surgery and remain smoke-free for 1 month after surgery.
If you have a mini-abdominoplasty, you may be released on the day of surgery. A full abdominoplasty usually requires 1 or 2 days in the hospital. For the first few days, the abdomen will be swollen, bruised, and painful, but medications can control the discomfort.
You will probably be unable to stand up straight for at least a week after a full abdominoplasty. Even if you can't stand straight, it is still important to start walking as soon as possible, usually the evening of surgery. This is the best way to reduce the chance of getting a blood clot in the legs, a risk that accompanies most types of abdominal surgery. Bending, straining, or lifting anything must be avoided for several days so the incision is not stressed or stretched.
It may take weeks before you feel like your old self again. If you start out in top physical condition with strong abdominal muscles, recovery from abdominoplasty will be much faster. Some people return to work after 2 weeks, while others take 3 or 4 weeks to rest and recuperate.
Exercise will help you heal better. Even people who have never exercised before should begin a gentle exercise program to reduce swelling, lower the chance of blood clots, and tone muscles. Vigorous exercise, however, should be avoided until you can do it comfortably.
Tummy tuck scars may appear to worsen during the first 3 to 6 months as they heal, but this is normal. Expect it to take 9 to 12 months before your scars flatten out and lighten in color. Although they will never disappear completely, abdominal scars will not show under most clothing, even bathing suits.
Length Of Surgery
1 to 4 hours, depending on the extent of the abdominoplasty
Anesthesia
General
In/Outpatient
Usually 1 night in the hospital, though mini-abdominoplasty may be done on an outpatient basis.
Tummy Tuck : Side Effects
Temporary pain. Swelling, soreness, numbness of abdominal skin, bruising, tiredness for several weeks.
Tummy Tuck : The Risks
Blood clots. Infection. Bleeding under the skin flap. Poor wound healing resulting in conspicuous scars or skin loss. Need for a second operation.
Tummy Tuck : The Recovery
Back to work: 2 to 4 weeks.
More strenuous activity: 4 to 6 weeks or more.
Fading and flattening of scars: 6 to 18 months.
Duration of Results
Considered permanent, unless weight gain or pregnancy occurs. Some skin and muscle tone is lost with aging.
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Lower Body Lift
All plastic surgery procedures called "lifts" basically reposition and tighten skin and underlying tissue to the location where it used to be when we were younger. Lifts reverse what gravity and time have done, so a facelift or a breast lift produces a younger-looking contour. A body lift is no different.
Sometimes, more than one part of the body has irregular contours, excess fat, and loose, sagging skin. The solution may be a full lower body lift that re-contours multiple body regions at once. This becomes an option if there is loose skin and tissue that liposuction alone cannot treat, or an abdominoplasty will not meet a patient's goals because it cannot correct the contour of the buttocks, hips, flanks, and thighs.
A circumferential body lift basically combines several procedures to treat the complete circumference of the body-front, back, and sides. It is also called a lower body lift because it has the greatest impact on the contour of the abdomen, waist, hips, buttocks, and thighs. A circumferential body lift produces a firmer, more youthful-looking contour by addressing many areas at once:
- The abdomen, lower back area, and flanks
- The buttocks, which may be sagging, flat or unevenly shaped
- The front, back, and outer thighs
A full body lift is a lengthy surgery but can produce remarkable improvements in all-over body contour. The surgeons at BodyAesthetic Plastic Surgery are nationally recognized as being leaders in this type of full-body surgery, and they have developed innovative techniques for achieving excellent results in their circumferential body lift patients.
In a circumferential body lift, excess fat and sagging skin are removed and the remaining tissue is repositioned. Although sometimes performed in combination with liposuction, a body lift differs from liposuction because it tightens and lifts the skin and underlying tissue. For some patients, a body lift is needed after large-volume liposuction to remove (excise) loose skin that no longer has the elasticity to retract and re-form to the post-liposuction contour. A body lift also improves a dimpled, irregular skin surface, commonly known as cellulite, by tightening the skin.
Body lift surgery may be appropriate for people who have "loose" tissue in multiple body areas but are of stable weight that is reasonably proportionate to their height and body frame. It is also the best option for massive weight loss patients who have large excesses of loose, sagging skin.
A lower body lift can be performed on any healthy adult who has realistic expectations and is willing to accept the fact that a scar will extend around the body circumference. Even though this is a large scar, it is acceptable to most patients because its location is hidden by clothing, even most bathing suits.
Some patients receive sufficient benefit from a less than circumferential body lift, in which the abdominoplasty component of the surgery is continued around the flanks but not across the whole width of the lower back. Other patients desire that the lifting effect be extended to their hips, buttocks, and thighs. The posterior portion of a circumferential body lift, called a thigh and buttock lift, is the most effective and long-lasting way to improve cellulite caused by skin laxity.
Your surgeon will explain all the options and help you decide how much "lifting" will best meet your body contouring goals. Because the extent of a body lift depends on each patient's anatomy and preferences, no two body lifts are exactly alike.
The greatest advantage of a circumferential body lift is that multiple areas are re-contoured in a single surgery, though this surgery is lengthy and recovery is not quick. It is appropriate for people who have lost a lot of weight, those who have suffered sun damage that contributes to premature aging and sagging of the skin, and people showing signs of the natural aging process or results of pregnancy, which cause skin and tissue to lose its tone and elasticity over time.
Other body contouring procedures may be performed separately or in the same surgical session as a body lift, such as liposuction, a breast lift, male or female breast reduction, brachioplasty (arm lift) or inner thigh lift. Not all patients are good candidates for combined procedures and safety may dictate that liposuction or re-contouring lifts in areas other than the lower body be staged, or performed in a separate surgery. Your surgeon will explain your options based on your general health, medical history, and lifestyle.
The Surgery
Most circumferential body lifts of BodyAesthetic Plastic Surgery patients are performed by two surgeons working together to reduce the total operative time. Even with two surgeons, a circumferential body lift takes between 3 to 5 hours. If additional procedures are performed in the same surgery, the operative time will increase. For example, a breast lift or breast reduction will add approximately another 1-1/2 to 3 hours to the time of a lower body lift.
Body lifts are performed in the hospital under general anesthesia, and patients are admitted to spend 2 to 3 days in the hospital, depending on the extent of the surgery, a patient's health status, the need for pain medication, and the amount of assistance a patient needs for moving around.
In a complete lower body lift, the front, back, and sides of the body are re-contoured. On the front, the incision is made just above the pubic bone and extended toward the back in a curved fashion below the protrusions of the hip bones. The skin and tissue above and below the incision are elevated (raised) as tissue flaps, which are pulled downward or upward into a new position. The excess skin and fat of the flaps are then excised. The deeper tissues that have been elevated and repositioned are tacked down to provide support and prevent them from moving.
If the skin around the navel has been removed, a new navel is created in a procedure called an umbilicoplasty. The skin and underlying tissues around the navel and above the waist are pulled downward to contour the waist and upper part of the tummy. When the skin and tissues below the incision are pulled upward, the front of the thighs and sagging in the groin area are "lifted."
To treat the back, the incision is carried around the hips and across the back and buttocks below the waist. This incision is placed slightly lower than what is called the bikini line. When the skin flaps are raised, the tissue above the incision is pulled downward to re-contour and smooth the waist and flank area (roughly that region over the kidneys). The skin and tissue below the incision are pulled upward to lift the outer and posterior thighs and the buttocks into a new position. The excess skin is trimmed off from the upper and lower flaps, and the underlying tissues are secured in the new position.
The skin above and below the incision in front and in back is stitched together and sealed with DermaBond (the medical equivalent of superglue) to keep the wound clean, dry, and secure.
What To Expect After A Circumferential Body Lift
Body lift patients usually have 4 drainage tubes that exit in the pubic area to prevent fluid from collecting beneath the skin flaps that were repositioned during surgery. You will also probably have a urinary catheter at least through the first night after surgery so you don't have to worry about going to the bathroom. In addition, you will receive fluids through an IV tube in your arm. This means you will have more tubes coming out of your body than you've probably ever had before, but they are there to make you more comfortable and prevent complications--and they won't remain for long.
With an incision that encircles your lower torso, you will find it difficult to get comfortable for a few days, and you will be unable to stand up straight. You will receive pain medication in the hospital and to take home with you. Even though you will be in pain and have trouble moving, you must get out of bed and walk, starting the morning after surgery, to help prevent blood clots from forming in the legs, which is the most serious potential complication that can occur after a full body lift.
Such a large incision will take some time to heal. Bending, straining, lifting, standing fully upright, or doing anything that will put stress on the incision must be avoided for several days. Basically, you need to protect the internal sutures that are supporting your new contour as well as the incision you can see. Your surgeon will give you detailed instructions for what you may and may not do until you have healed.
Incision stitches are usually removed in 7 to 14 days, depending on how you heal, though the majority of sutures are beneath the skin and do not have to be removed. You should be able to return to work and light, normal activities within 2 or 3 weeks, as long as you do not engage in heavy lifting or vigorous exercise.
Even though you will be swollen for a few months and bruised for a few weeks, your new body contour will be immediately apparent. However, the final result may take several months to emerge completely as the swelling gradually subsides and your skin and tissues settle into their new positions. You will likely have some numbness in areas of your skin, which will also feel unusually firm, but this will diminish over time. It may take a year or more for your scar to fade and refine, though it will never be invisible.
Even though a circumferential body lift is a lengthy surgery and the first few weeks may be difficult and uncomfortable, patients who have this surgery are extremely satisfied with the final results. Their new smoother, smaller, and lifted body contour makes a remarkable difference in how patients feel about themselves, activities they can engage in, and clothing they can wear.
Length Of Surgery
3 to 5 hours
Anesthesia
General
In/Outpatient
Inpatient, with a hospital stay ranging from 2 to 3 days or longer if other body contouring procedures are also performed.
Side Effects
Temporary pain and discomfort. Difficulty moving for several days. Swelling, soreness, bruising, and numbness of skin. Tiredness for several weeks.
Risks
Blood clots. Infection. Bleeding under the skin flaps. Poor wound healing resulting in conspicuous scars or skin loss.
Recovery
Back to work: 2 to 4 weeks.
More strenuous activity: 4 to 6 weeks or more.
Fading and flattening of scars: 6 to 18 months.
Duration of Results
Considered permanent, unless weight gain or pregnancy occurs. Some skin and muscle tone is lost with aging.
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Arm Lift
An arm lift, also known as brachioplasty, is a surgical procedure that removes loose skin and excess fat deposits in the upper arm. With age or weight loss, upper arm skin can become loose and flabby, producing what is commonly known as a "bat wing" appearance. Skin tone is lost through the normal aging process or major weight loss.
Women are primarily affected by this arm deformity, which can make someone so self-conscious that she refuses to ever wear short sleeves. Arm exercises can rarely correct the skin laxity once it has developed, and people who have never been overweight may still have loose skin in the upper arm.
In some cases, liposuction alone can correct upper arm contour deformities. For other patients, excision (removal) of the excess skin is the only way to get rid of that "flappy" tissue that hangs from the inner, upper arm. Fat deposits and excess skin can also be removed from the armpit and the area just in front of the armpit during a brachioplasty. In addition to producing a significant cosmetic improvement in arm contour, a brachioplasty also makes clothes fit much better.
The Surgery
In a brachioplasty, the contours of the upper arm and armpit area are smoothed and tightened by removing excess skin through an incision typically placed on the inner surface of the upper arm. The length of this incision depends on how far down the arm the excess skin and fat deposits extend, but it may run along the underside of the entire upper arm.
An arm lift usually takes 1-1/2 to 2 hours, followed by quick recovery and return to normal activities. Although a brachioplasty can be performed alone, most patients have it done in combination with other body lifting procedures.
The scar on the underside of the upper arm that results from an arm lift will never be invisible and may remain red and quite noticeable for up to a year. With sufficient time, the scar should fade and form a thin line that is visible only when the arms are raised.
Length Of Surgery
1-1/2 to 2 hours
Anesthesia:
Usually general
In/Outpatient
Outpatient if brachioplasty is performed alone. If other procedures are done in the same surgery, patients spend 1 or 2 nights in the hospital.
Side Effects
Temporary pain and discomfort, arm swelling, bruising, change in arm sensation.
Risks
Scars that may be conspicuous in short sleeves. Wide scars. Contour irregularities of arms. Bleeding under skin flaps. Blood clots. Infection. Permanent numbness in some areas of skin.
Recovery
Back to work: 1 to 2 weeks.
More strenuous activity, especially lifting: 4 to 6 weeks.
Fading and flattening of scars: 6 to 18 months.
Duration of Results
Considered permanent, unless weight gain occurs.
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Facelift
From their premier, St. Louis plastic surgery office, the talented surgeons of BodyAesthetic Plastic Surgery & Skin Care Center treat St. Louis facelift patients. In the paragraphs below, the facelift procedure is described. To view the results achieved by some St. Louis facelift patients, please scroll down to view before and after photos.
As people age, the effects of gravity, exposure to the sun, and the stresses of daily life can be seen in their faces. Deep creases form between the nose and mouth; deep wrinkles are prominent, especially in the cheeks, and the skin sags; the jaw line grows slack and is less well-defined; skin folds and fat deposits appear around the neck. A facelift (technically known as rhytidectomy) improves the most visible signs of aging by removing or repositioning subcutaneous tissue, excess fat, tightening underlying muscles, and redraping the skin of your face and neck. A facelift can be done alone or along with other procedures such as a forehead lift, eyelid surgery, or nose reshaping.
The result of a facelift is a younger and refreshed look. The best candidates for a facelift are men and women whose face and neck have begun to droop but whose skin still has good elasticity and well-defined bone structure. Most patients are between the ages of 40 to 70, but facelifts can be done successfully on people in their 70s or 80s.
Facelifts are very individualized procedures because no two faces are exactly alike. In your initial consultation, your surgeon will evaluate your face, including the skin and underlying bone structure, and the severity of wrinkles and folds. He will also discuss your goals for the surgery and explain the type of facelift most appropriate for you.
Facelift : The Surgery
Incisions usually begin above the hairline at the temples, extend in a natural line in front of the base of the ear to just inside the cartilage at the front of the ear, and continue in the crease behind the ear and into the lower scalp. If the neck needs lifting, a small incision may also be made under the chin.
In general, the surgeon separates the skin from the fat and muscle below. Fat may be trimmed or suctioned from around the neck and chin to improve the contour. The surgeon then tightens the underlying muscle and fascial tissue and elevates the skin upward and back, then trims off the excess.
The stitches used to secure the layers of tissue and close the incisions are typically removed after 5 to 7 days. Because your scalp may take longer to heal, the stitches in your hairline may be left in a few days longer. Your head will be wrapped loosely in bandages after surgery to minimize bruising and swelling, but they will be removed the following day, as will two small drains placed during surgery. When the bandages and drains are removed, you may shower and wash your hair. Although your face will be pale, bruised, and puffy at first, you'll look much better in a week or so. If you need it, special camouflage makeup can mask most bruising that remains.
What To Expect After A Facelift
There usually isn't significant discomfort after surgery, but your surgeon will give you a prescription for pain medication. (Severe or persistent pain or sudden swelling of the face should be reported to your surgeon immediately.) Some numbness of the skin is quite normal, but it will disappear in 3 to 6 months.
Your head should remain elevated and as still as possible for a couple of days after surgery to reduce swelling. Once you're up and about, take it easy for the first week after surgery. Be especially gentle with your face and hair, since your skin will be both tender and numb. Your surgeon will give you specific guidelines for gradually resuming normal activities.
About 85% of the swelling will be gone in about 3 weeks, but the final results of a facelift may not be fully apparent for up to 6 months. Initially, your face will probably look and feel strange, with your features distorted from the swelling and facial movements slightly stiff. The scars from a facelift are usually hidden by hair or in the natural creases of the face and ears, but they will fade over time and should be scarcely visible.
Results of a facelift are not permanent and you'll continue to age with time. However, the effects are lasting in the sense that you have "turned back the clock." Seven to ten years after a facelift, you'll look basically the way you did before surgery.
Length of surgery
3 to 5 hours, depending on the type of facelift performed
Anesthesia
Usually general
In/Outpatient
Usually 1 night in the hospital. If multiple procedures are performed, you may chose to spend a second night.
Facelift : Side Effects
Temporary bruising, swelling, numbness and tenderness of skin; tight feeling, dry skin. For men, permanent need to shave behind ears, where beard-growing skin is repositioned.
Facelift : The Risks
Injury to the nerves that control facial muscles or sensation(usually temporary but may be permanent). Infection, bleeding, poor healing, or excessive scarring. Asymmetry or change in hairline or ear position.
Facelift : The Recovery
Back to work: 10 to 14 days.
More strenuous activity: 2 weeks or more.
Bruising: 2 to 3 weeks. Limit sun exposure for several months.
Duration of Results
Usually 7 to 10 years.
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Browlift
A browlift (also called a forehead lift) corrects the drooping or low position of the eyebrows that gives the face a tired or sad appearance. It also softens horizontal creases across the forehead, as well as the vertical lines (frown lines) between the eyebrows that contribute to an unhappy or angry expression. Many people have eyebrows that are not positioned symmetrically, and this can be corrected with a browlift. A lot of patients who request a forehead lift say that people ask if they are mad, tired, or worried because they always seem to be frowning.
A browlift rejuvenates the area between the upper eyelids and the scalp across the entire forehead (temple to temple) to produce a more relaxed and refreshed appearance. It is most often done on people over 40. Many patients elect to have a browlift in combination with other facial procedures, such as a facelift or eyelid lift (blepharoplasty).
The Surgery
The surgeons at BodyAesthetic are trained to perform a browlift with an endoscope, which requires 4 or 5 short incisions in the hair. The endoscopic approach is not as successful as the traditional browlift for treating horizontal creases across the forehead, but it does effectively raise the eyebrows and improves the vertical frown lines at the top of the nose. The scars from an endoscopic browlift are usually imperceptible, and the healing time is shorter than with a traditional browlift.
If the amount of forehead skin is excessive, or if significant horizontal wrinkles are present, a traditional browlift may be the best option. In this case, an incision is made across the top of the scalp, just behind the hairline. In patients with a high forehead, the incision is placed just below the hairline so the hairline will not be raised to an unnaturally high position. The resulting scar usually blends nicely into the hairline.
Whichever incision is used, a browlift removes excess forehead tissue and skin, repositions the muscles and tissues that cause wrinkling and frown lines, and tightens the forehead skin. The result is that the eyebrows are raised and the forehead smoothed.
The procedure takes about 1 1/2 hours and may be done on an outpatient basis. If a browlift is combined with other procedures, such as a facelift or eyelid lift, patients usually spend one night in the hospital.
What To Expect After A Browlift
A light dressing is placed over the incision, but it is removed the day after surgery, at which point you may shower. Your scalp will be tender and you'll have some discomfort for a few days, but your surgeon will prescribe medication that should relieve most of the pain. For the first day after a browlift, your head should remain elevated. Even with this precaution, swelling and bruising of the forehead will increase over the first 2 to 3 days before it begins to subside. Because the skin and tissues surrounding the eyes are thin, some swelling and bruising usually occurs around the eyes, as well.
Stitches are removed 7 to 10 days after surgery, and you should feel and look good enough to return to work--or in less time with an endoscopic browlift. By about 10 days postop, most of the bruising should be gone, and what remains can be concealed with make-up. By this time, you will definitely notice that your facial expression seems more refreshed and relaxed. Within 3 weeks, about 85% of the swelling has subsided. However, your final appearance may not be fully evident for up to 6 months.
Length Of Surgery
1 to 2 hours
Anesthesia
Usually general
In/Outpatient
Usually outpatient; if performed along with other procedures, patients spend 1 night in the hospital.
Side Effects
Temporary swelling, numbness, headaches, bruising. Traditional browlift method: Possible itching and hair loss around the incision.
Risks
Injury to facial nerve, causing loss of motion, muscle weakness, or asymmetrical look. Infection. Broad or excessive scarring.
Recovery
Back to work: 7 to 10 days, usually sooner for endoscopic browlift.
More strenuous activity: 2 weeks.
Full recovery from bruising: 2 to 3 weeks. Limit sun exposure for several months.
Duration of Results
Usually 5 to 10 years
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Rhinoplasty
At their St. Louis plastic surgery practice, the talented surgeons of BodyAesthetic Plastic Surgery & Skin Care Clinic perform rhinoplasty procedures. They have helped many St. Louis rhinoplasty patients improve the symmetry and balance of their facial profiles. In the paragraphs below, the rhinoplasty procedure is described.
Rhinoplasty, or surgery to reshape the nose, is one of the most common plastic surgery procedures. It can reduce or increase the size of your nose, change the shape of the tip or the bridge, narrow the span of the nostrils, or change the angle between your nose and your upper lip. A septoplasty is more reconstructive than cosmetic and may be needed after an injury and/or to help relieve some breathing problems. Serious nasal injuries or birth defects may require more involved reconstruction. Nose surgery done for medical and reconstructive reasons may be covered by insurance.
The nose is one of the most prominent features of the face and impossible to disguise. Rhinoplasty can enhance appearance and self-confidence, but the best candidates are people looking for improvement, not perfection, which is an impossible goal. You may have ideas about what you want your nose to look like, but a good rhinoplasty will fit your particular face in shape and proportion rather than look like it came from someone else. The surgeon you choose can make all the difference in whether a rhinoplasty looks natural or like a "nose job."
Most surgeons prefer not to operate on teenagers until after they've completed their growth spurt, usually around age 14 or 15 for girls and a bit later for boys. However, an abnormally large or misshapen nose can interfere with the social and emotional adjustment of teenagers, who may suffer relentless teasing or ridicule from their peers. Thus, some rhinoplasty and septoplasty patients are teenagers, but most are adults who have always disliked the shape or size of their noses and finally decide to do something about it.
Rhinoplasty : The Surgery
During rhinoplasty the skin of the nose is separated from its supporting framework of bone and cartilage, which is then sculpted to the desired shape. The nature of the sculpting will depend on what you want to change about your nose. Finally, the skin is redraped over the new framework. Most rhinoplasties are performed from within the nose so no incision will be seen externally. In more complicated cases, a small incision may be needed across the columella (the vertical strip of tissue separating the nostrils called the septum). A septoplasty is more likely to focus on repairing the internal structures of the nose rather than re-contouring the skin.
When the surgery is completed, a splint is applied to help your nose maintain its new shape and structure. Nasal packs or soft plastic splints may be placed in your nostrils to stabilize the septum (the dividing wall between the air passages).
What To Expect After A Rhinoplasty Or Septoplasty
During the first 24 hours, your face will feel puffy, your nose may ache, and you may have a dull headache. This discomfort can be controlled with pain medication prescribed by your surgeon. Applying cold compresses will reduce the swelling and make you feel a bit better. Plan on staying in bed with your head elevated (except for going to the bathroom) for the first day.
A little bleeding is common during the first few days following surgery, and you may continue to feel some stuffiness for several weeks. At first you'll feel a lot better than you look. Swelling and bruising around your eyes will peak after 2 or 3 days but should disappear within 2 weeks or so. Some subtle swelling that is basically unnoticeable to anyone but you and your surgeon will remain for several months.
Nasal packing is usually removed the day after surgery, at which point you'll feel much more comfortable. By the end of 1 week, all dressings, splints, and stitches should be removed.
Most rhinoplasty and septoplasty patients are up and about within 2 days and able to return to school or sedentary work a week or so following surgery. Strenuous activity should be avoided for 2 to 3 weeks; this includes jogging, swimming, bending, sexual relations, or any activity that increases your blood pressure. Avoid hitting or rubbing your nose, or getting it sunburned, for 8 weeks. Be gentle when washing your face and hair or using cosmetics. It may take several weeks before you're entirely up to speed. Although the final results of rhinoplasty or septoplasty may not appear for about a year, an improved appearance is visible within 2 weeks or so, when the swelling subsides.
You can wear contact lenses as soon as you feel like it, but eyeglasses are another story. Once the splint is off, glasses will have to be taped to your forehead or propped on your cheeks for another 6 to 7 weeks, until your nose is completely healed.
Length Of Surgery
1 to 2 hours or more
Anesthesia
General
In/Outpatient
Usually outpatient. More complex cases may require brief hospitalization.
Rhinoplasty : The Side Effects
Temporary swelling and bruising around the eyes and nose. Headaches. Some nose bleeding and stuffiness. Temporary loss of smell, numbness of nasal tip, or nasal congestion.
Rhinoplasty : The Risks
Infection. Small burst blood vessels resulting in tiny, permanent red spots. Incomplete improvement that requires additional surgery.
Rhinoplasty : The Recovery
Back to work: 1 to 2 weeks.
More strenuous activities: 2 to 3 weeks.
Avoid hitting nose or sunburn: 8 weeks.
Final appearance: 1 year or more.
Duration of Results
Permanent
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