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What is Facelift Surgery?
Face lift surgery, or a rhytidectomy, is designed to restore a more youthful appearance by removing major wrinkles and sagging skin. It involves tightening of the facial and neck muscles as well as the removal of any excess skin.
The skin begins to wrinkle and sag as a result of age, sun exposure and genetics. Children and young adults have smooth, round faces due to evenly distributed fatty tissues in facial contours. Over time, the skin sags and folds causing the chin, jawline and neck to become prominent. Not only does a facelift improve facial appearance but also has a dramatic effect on the neck, enhancing its contour and profile. For a facelift in Newport Beach California contact Dr. Seify today.
A face lift can make a patient look 5 to 10 years younger.Dramatic as the end results are, this is not a simple procedure. It requires a week to 10 days of recovery.
Before Face Lift Surgery
We will evaluate your medical history in order to determine your overall health. Your doctor will discuss with you how your face can look and what you can expect from surgery. Our objective is to create a natural appearance that is pleasing to you. Before and After photographs will reveal what the surgery has accomplished.
Preoperative Instructions:
Avoid drugs that contain aspirin several weeks prior to surgery to minimize excess bleeding. You may be required to take antibiotics to prevent infection. You may be instructed to shampoo your hair the night before surgery. A small amount of hair may be shaved around your ears and temples.
The Face Lift Procedure
A face lift is frequently performed in conjunction with blepharoplasty (eyelid surgery), forehead lift, chin augmentation, and/or liposuction, to create an overall rejuvenation of the face. The procedure can be repeated as gravity continues its effects after the first surgery.
Face lifts are performed in our surgery center under general anesthesia for total patient comfort. The surgeon will make incisions inside the hairline at the temple, in front of the ear, then around the earlobe and behind the ear, ending at the scalp area. Excess skin is removed and sagging muscles and connective tissues are tightened. Neck contouring may require an incision under the chin. Incisions are closed with small sutures.
The procedure may take up to 5 hours depending on whether any other procedures are performed at the same time.
Post Operative Care
We recommend that you stay in our overnight suite or have someone drive you home and stay with you for the first 24 hours. Initially you will have a dressing wrapped around your head. You may or may not have surgical drains attached to bulbs hanging at your neck. These will be removed in approximately 24 hours. Stitches around the ears will be loosened or removed in a few days. The scalp sutures will be removed in 7-10 days.
To minimize scarring, the doctor may remove the sutures in stages. Scarring fades quickly. Swelling and discoloration decrease within two weeks. Tightness in your face will be present for several weeks and there may be slight changes in your hair pattern around the incision.
We recommend that you avoid the sun for several weeks after surgery.
Complications following facelift are rare. These include bleeding, infection, loss of skin behind the ears, facial nerve injury, and discoloration of the skin, numbness, and asymmetry and scarring. Infection is rare due to the large blood supply to the face. As mentioned, the risk of bleeding is greater if you take aspirin or blood thinners within 2 weeks of the surgery. The risk of wound complications increases in diabetics, persons with a history of radiation, autoimmune and collagen disease as well as in smokers.
By following pre- and post-operative instructions, you will minimize potential problems. For a facelift in Newport Beach California contact us today.
Recovery: What to Expect
In the weeks following surgery, the facial skin and area around the ear may be numb. There may also be some temporary discoloration as healing begins, which may take a few months to disappear. Occasionally, a facial nerve is bruised during surgery, resulting in temporary loss of function or sensation. However, actual permanent damage to the facial nerve is rare.
The healing process is gradual, so you will not notice final results for up to 6 months. A single procedure often achieves the desired results. Most patients who have had facelifts are pleased with their new, more youthful appearance.
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What is an Endoscopic Forehead Lift?
Endoscopic Forehead Lift
A forehead lift, also called a "brow lift", restores a more youthful, revitalized appearance to the area above the eyes. The procedure corrects drooping brows and improves the lines and wrinkles that can make you appear tired, sad or angry. In a forehead lift, the muscles and tissues that cause the wrinkles or drooping are removed or repositioned in order to smooth the forehead, elevate the eyebrows and diminish frown lines.
The forehead lift is performed through small incisions in the scalp (within the hair). The actual surgery is accomplished with the use of an endoscope (lighted video camera) and special instruments through these small incisions. As previously mentioned the muscles that cause wrinkling between the eyes can be removed during this procedure. The forehead is then lifted to the appropriate level and secured in place with either a small screw that is removed after two weeks or an internal tine that eventually absorbs.
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What is the Mid-Face Lift, or Cheek Lift?
The mid-face lift procedure (cheek lift)
The primary goal of the cheek lift is to elevate and tighten the soft tissues of the cheek. This will result in the restoration of a more youthful lower eyelid-cheek junction, with softening of the fold between the nostril and cheek, and repositioning of the cheek tissue in a more youthful position. The cheek lift moves the cheek upward producing a more natural appearance (less pulled) than the "classical" face lift, which pulls tissue more towards the ear. Lifting the cheek upward counteracts the influence of gravity and restores a more youthful cheek contour.
The cheek lift is performed through an incision below the lashes of the lower eyelid. The skin and muscle of the lower eyelid is elevated down to the bony rim of the orbit. At this point the tissue of the cheek is lifted off of the bone down to the level of the nostril so that the entire cheek can be repositioned in a more youthful location. The cheek is then secured in place and reinforced with various suture techniques. Any excess eyelid skin and muscle are then trimmed, and the skin incisions are closed.
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What is Eyelid Surgery, or Blepharoplasty?
Blepharoplasty (Eyelid Surgery)
Upper and lower eye lid surgery is one of the most common cosmetic surgery procedures performed at Newport Plastic & Reconstructive surgery. This information is put together as to help our patients understand the different aspects of this highly technical procedure.
Successful plastic surgery is a result of good rapport between patient and surgeon. Trust, based on realistic expectations and exacting medical expertise, develops in the consulting stages before surgery. Your surgeon can answer specific questions about your specific needs.
Droopy eyelids can make you look older and can also impair vision. In many cases it is the first sign of facial aging. A tired, staring or stressed look are one of the main complaints voiced by our patients.
Eye lid surgery (Blepharoplasty) corrects these problems and also removes puffiness and bags under the eyes that make you look worn and tired. This procedure cannot alter dark circles, fine lines and wrinkles around the eyes, nor can it change sagging eyebrows. Though blepharoplasty is often performed as a single procedure, your surgeon may also recommend a brow lift, facelift, or skin resurfacing to achieve the best results.
Are you a good candidate for eye lid surgery?
As with all plastic surgery procedures, good health and realistic expectations are prerequisites. Blepharoplasty removes the excess fat, muscle, and skin from both upper and lower lids. The results can be a refreshed appearance, with a younger, firmer eye area.
People with severe circulatory, ophthalmologic, or other serious medical conditions must rely on the diagnostic skills of their own personal specialists to determine whether blepharoplasty is an option to consider. Consultation with a plastic surgeon can help you decide whether any additional, complementary surgery would increase the success of the surgery.
Choosing your plastic Surgeon:
Whether the surgery is desired for functional or cosmetic reasons, your choice of a qualified plastic surgeon is of paramount importance. Board certification, proper training, hospital affiliation, society membership etc... Are among the main things that we advise our patients to check before requesting a consultation.
Surgical consultation:
During the pre-surgical consultation, you will be examined or asked to answer queries concerning vision, tear production, use of lenses, and your desires for surgery. Your surgeon will explain what you can expect from blepharoplasty and take a complete medical history. Factors to be weighed include age, skin type, ethnic background, and degree of vision obstruction. Furthermore, you can expect an open and honest exchange between you and your surgeon, which will establish the basis for a successful outcome.
After a mutual decision is made by both you and your surgeon, the technique indicated for your individual surgery will be discussed. The type of anesthesia, the surgical facility, any supportive surgery, and the risks and costs inherent in the procedure will be outlined.
Understanding the Surgery:
In upper eyelid surgery, the surgeon first marks the individual lines and creases of the lids in order to keep the scars as invisible as possible along these natural folds. The incision is made, and excess fat, muscle, and loose skin are removed. Fine sutures are used to close the incisions, thereby minimizing the visibility of any scar.
In lower eyelid surgery, the surgeon makes the incision in an inconspicuous site along the lash line and smile creases of the lower lid. Excess fat, muscle, and skin are then trimmed away before the incision is closed with fine sutures.
Newer techniques involving redraping the fat rather then complete excision are preferred. Proper knowledge of different factors related to eye lid tone and closure insures a safe outcome. Special training in Occuloplastic surgery is a plus.
Eyelid puffiness caused primarily by excess fat may be corrected by a transconjunctival blepharoplasty. The incision in this case is made inside the lower eyelid, and excess fatty material is removed. When sutures are used to close this kind of incision, they are invisible to the eye. They are also self-dissolving and leave no visible scar. Under normal conditions, blepharoplasty can take from one to two hours.
What to Expect After the Surgery
Immediately after the surgery has been completed, your surgeon may apply tiny sterile bandages. This is not done for transconjunctival blepharoplasty. It is not crucial that the eyes be covered. However, an ointment to prevent dryness of the eye area may be used. A certain degree of swelling and bruising is normal. Cold compresses, as well as head elevation when lying down, will enhance healing and relieve discomfort. Your surgeon will prescribe medication for discomfort.
For a week and a half following blepharoplasty, you will clean the eye area (the eyes may feel sticky, dry, and itchy). Eye drops may be recommended. Your surgeon will also list activities and environments to avoid in the weeks immediately following surgery. Permanent stitches will be removed in five to seven days after surgery. Self-absorbing stitches will dissolve on their own.
Insurance does not generally cover surgery that is done purely for cosmetic reasons. Surgery to correct or improve vision or surgery for eye deformity or injury may be reimbursable in whole or in part. It is the patient's responsibility to check with the insurance carrier for information on the degree of coverage
Plastic surgery makes it possible to correct many facial flaws and signs of premature aging that can undermine self-confidence. By changing how you look, facial plastic surgery can help change how you feel about yourself.
Special topics related to eye lid surgery:
1-Ptosis: Droopy eye lid due to abnormal muscle or other tissues is a common finding during blepharoplasty consults. Special attention to this finding during surgery is of paramount importance to insure a good outcome free of complications.
2-Cheek lift (midface lift): A commonly used technique in conjunction with lower lid surgery to insure proper redraping of the mid face and restoration of a smooth eye lid –cheek junction. No additional incisions are required for this approach .The degree of midface dissection is related to the degree of the deformity.
3-Fat grafting: An important part of the mechanism of aging is loss of facial volume. We like to ask our patients to bring old photographs to the consultation to study the facial changes and the need for adding volume through injection of fat. (Please refer to the section on fat grafting for more details).
References:
1- Seify, Hisham MD; Hester, T Roderick MD. The Use of Microfat Grafting in Periorbital Rejuvenation: Review of 100 Consecutive Facelifts: 24.Plastic & Reconstructive Surgery. 116(3) Supplement: 31-32, September 1, 2005.
2- McCord, Clinton D. M.D.; Seify, Hisham M.D.; Codner, Mark A. M.D. Transblepharoplasty Ptosis Repair: Three-Step Technique. Plastic & Reconstructive Surgery. 120(4):1037-1044, September 15, 2007.
3-The American society of plastic surgeons.
4-The American academy of facial Plastic & Reconstructive Surgery.
5-The American Society for aesthetic plastic surgery.
6-The American society of plastic surgeons.
7-The American academy of facial Plastic & Reconstructive Surgery.
8-The American Society for aesthetic plastic surgery.
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What is Rhinoplasty, or Nose Surgery?
Rhinoplasty
Rhinoplasty is a surgical procedure in which deformities of the nose are corrected by removing, rearranging or reshaping bone or cartilage. Appearance can be improved for those people who are dissatisfied with the shape and size of their nose. Nasal reconstruction was one of the first cosmetic procedures ever developed and is among those most frequently performed today.
Reasons for Surgery
Reasons include reducing the size of the nose, removal of bumps as well as improving the angle of a nose. Conditions may be natural or due to external trauma to the face. This operation will also help patients who have difficulty breathing. The operation can be performed on all age groups, including teens and the elderly.
Before Surgery
A medical history along with a careful examination is conducted in order to evaluate your general health. We will discuss with you the way your nose can look in relation to your other facial features. Digital photographs and computer imaging allow your doctor to evaluate the appropriate procedure to achieve the desired results. Pre-operative instructions may include the elimination of certain drugs that contain aspirin in order to minimize the possibility of excess bleeding. Antibiotics may be prescribed before surgery to prevent infection.
Method of Surgery
Surgery is usually performed under general anesthesia for total patient comfort. In most cases involving a reduction in shape or size of the nose, angle or removal of a hump, the skin of the nose is separated from the underlying skeleton of bone and cartilage. The bone and cartilage are then reshaped and the skin re-draped over the surface. Patients who have a deviated septum may benefit by correction of this problem. The incisions are placed inside the nose, unless the surgeon uses an open approach, in which case the incisions are made across the tissue between the nostrils. In cases where the nostrils flare, the surgeon may make an incision at the junction between the nose and the skin of the upper lip to narrow the flared appearance. It is not unusual to combine rhinoplasty with chin augmentation to improve the profile.
Post-Operative Information
The recovery takes one to two weeks. Most people resume their normal activities within a week or two. Following surgery, a lightweight splint is applied to maintain the new shape of the nose. The splint is removed within a week. Nasal splints may be inserted at the time of surgery to protect the septum. These are removed within a week. There is always some stuffiness of the nose, especially when work has been done on the nasal septum.
Pain is minimal and is controlled with medications. Bruising occurs around the eyes, but begins to fade within a few days. Discoloration usually disappears in two weeks.
Insurance
Your insurance company may pay for all or part of the costs associated with your surgery if it is performed as a result of nasal obstruction. It is recommended that you check with your carrier to determine if there is coverage.
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What is Skin Resurfacing?
Skin Resurfacing (Chemical Peels/laser/Dermabrasion)
The combined effect of sun damage and intrinsic skin result in facial aging frequently with wrinkles and fine lines. Different surgical techniques are used for the reversal of the mechanism of aging. A facelift or blepharoplasty alone cannot remove wrinkles and are especially inadequate for the fine wrinkles around the mouth, eyes and forehead. The chemical peel, dermabrasion and laser skin resurfacing procedures are used in the peri operative period to minimize these surface irregularities.
All three procedures remove the outer sun damaged layer of the skin, attempting to leave the patient with a smoother and more youthful appearance. The chemical peel procedure consists of the application of a medical mixture to the treated skin, which creates a controlled chemical burn. TCA (Trichloroacetic acid) is usually used in different concentrations. In the dermabrasion procedure, the outer layer is mechanically removed with a bur in a "sanding" motion. In the newer methods of laser skin resurfacing, various lasers can be employed to vaporize the outer layer of skin and induce a tightening of the remaining skin.
The result of the treatment is a general tightening of the skin with obliteration of many of the fine wrinkles and scars while making the deeper wrinkles and scars less noticeable. In patients with excessive wrinkling or scarring, a repeat procedure may be desirable, but complete obliteration of all lines, wrinkles or acne marks will not be possible in any patient. The use of a proper skin care program in addition to the resurfacing yield a better and more lasting result.
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What are Botox and Other Fillers?
BOTOX® & Fillers Injections
BOTOX® Cosmetic is a simple, nonsurgical, physician-administered treatment that can temporarily smooth moderate to severe frown lines between the brows in people from 18 to 65 years of age. It is the only treatment of its type approved by the Food and Drug Administration (FDA).
One 10-minute treatment—a few tiny injections—and within days there's a noticeable improvement in moderate to severe frown lines between the brows, which can last up to 4 months. Results may vary. BOTOX® Cosmetic is a purified protein produced by the Clostridium botulinum bacterium, which reduces the activity of the muscles that cause those frown lines between the brows to form over time. There’s only one BOTOX® Cosmetic. Find a doctor in your area that offers BOTOX Injections.
Could this be what you’ve been looking for—a procedure that can temporarily smooth those moderate to severe frown lines between your brows with no surgery and no recovery time? An improvement can be seen within days, lasting for up to 4 months. Results may vary.
Why would you get treated with BOTOX® Cosmetic?
- You think those stubborn frown lines between your brows make you look tired or upset.
- It seems like something that you could do to help maintain your appearance.
Not just models and movie stars, but people from all types of professions have tried it. In fact, the American Society for Aesthetic Plastic Surgery (ASAPS) ranked BOTOX® Cosmetic as the most popular physician-administered aesthetic procedure in the United States for the fourth year in a row (surgical and nonsurgical combined).
What's more, the ASAPS surveys ranked BOTOX® Cosmetic as one of the low-entry-cost facial aesthetic procedures in the United States. Almost 3.3 million procedures were performed in 2005 alone—a 16% increase over 2004. Not just models and movie stars, but people from all types of professions have tried it. In fact, the American Society for Aesthetic Plastic Surgery (ASAPS) ranked BOTOX® Cosmetic as the most popular physician-administered aesthetic procedure in the United States for the fourth year in a row (surgical and nonsurgical combined). What's more, the ASAPS surveys ranked BOTOX® Cosmetic as one of the low-entry-cost facial aesthetic procedures in the United States.
BOTOX® Cosmetic Injection Process
The beauty of a BOTOX® Cosmetic treatment is that it's a simple, 10-minute, non-surgical process. A few tiny injections, and within days there can be a noticeable improvement in the moderate to severe frown lines between the brows that can last up to 4 months. Results may vary. And there’s no recovery time. You can even do it on your lunch break.
- Your doctor will administer several tiny injections of BOTOX® Cosmetic directly into the muscles that cause those moderate to severe frown lines between the brows.
- Your doctor will determine where to administer the injections by examining your ability to move certain muscles in your brow area. The location, size, and use of the muscles that create a furrowed brow vary markedly among individuals.
- No anesthesia is required, although your doctor may choose to numb the area with a cold pack or anesthetic cream prior to injecting. Discomfort is usually minimal and brief.
- You can expect to be in and out of the physician’s office without downtime. You may see a marked improvement in the moderate to severe frown lines between your brows within days. Improvement may continue for as long as a month, and could last up to 4 months.
What To expect:
The Day of Your appointment: Allow time before your appointment for filling out forms and for consulting with the doctor or a member of his or her staff. If it's your initial visit, you may first meet with your doctor personally or a staff member. Many doctors have on-staff licensed aestheticians or nurses who are trained in skin care and skin care procedures who can answer many of your questions.
You may also be asked about your expectations for treatment and if you have any allergies or any condition that wouldn't make you a good candidate for BOTOX® Cosmetic. (See the full prescribing information for more details.)
Before the procedure: You'll probably be seated in a reclining chair, much like you find in a dentist's office. No anesthesia is required, although your doctor may choose to numb the area with a cold pack or anesthetic cream.
The procedure: Your doctor will determine where to administer the injections by examining your ability to move certain muscles in your brow area. The entire BOTOX® Cosmetic injection procedure takes approximately 10 minutes.
After the procedure: There's no recovery time needed. You're ready to get on with your day! The most common side effects following injection include temporary eyelid droop and nausea. Localized pain, infection, inflammation, tenderness, swelling, redness, and/or bleeding/bruising may be associated with the injection. Patients with certain neuromuscular disorders such as ALS, myasthenia gravis, or Lambert-Eaton syndrome may be at increased risk of serious side effects.
Seeing results: Within days, you may notice an improvement in the moderate to severe frown lines between your brows that can last up to 4 months. Results may vary.
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What are Chin and Facial Implants?
Chin & Facial Implants
The use of facial implants is a popular ancillary procedure with or without facial rejuvenation surgery. The most common implants are either made of silicone or a porous material called medpor.
The most commonly performed procedure in this group is chin augmentation. Most people feel that a stronger chin is more aesthetically pleasing than weak chin. This is usually discussed with the patient in the event of a rhinoplasty procedure as both procedures are complimentary in order to achieve a good facial balance.
Less frequently, patients will present with a narrow jaw and request enhancement of the angles of the mandible, or to give someone more prominent cheek bones.
Similar implants could be used to augment the nasal dorsum or to provide more tip support. (Please refer to the Asian nose in the rhinoplasty section).
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What is Micro Fat Grafting?
As we age, fat in certain parts of our body atrophies or dissipates leading to step-offs and hollowness on the face, and around the eyes. Fat injection procedures known as autologous fat transplantation or microfat injection, involves removing fat from an area of excess on your body. The fat cells are then injected to fill sunken cheeks or laugh lines between the nose and mouth, to correct skin depressions on indentations, to minimize forehead wrinkles, to improve step-offs around the eyelids and to enhance lips. Another excellent area for fat injection is the hand. As we age, the fat at the back of the hands may atrophy or go away. The tendons and veins on the back of the hands become more visible, giving the hands an irregular contour full of blue and white “cords.” Fat injection into such hands can replace lost fullness thereby correcting contour. The fat will also serve to hide tendons and veins on the back of your hands which are one of the typical signs of aging. As the injected autologous fat is harvested from you, it tends to last longer than injected bovine collagen.
Either local anesthesia with some sedation or general anesthesia may be used with this procedure. The fat is withdrawn using a special instrument so as not to injure the fat cells. The art of fat injection is in the removal of and processing of the fat so as not to injure the delicate fat cells. The prepared fat cells are next gently injected into the desired site with a special needle. As some of the injected fat cells resorb over the following weeks, overfilling is necessary. The swelling associated with fat injection tends to be more severe than with collagen. You may notice swelling especially at the lips for 2 weeks.
If a large area was treated, you should limit your physical activity for a brief time until the injected fat has set into its new location. Many patients, however, are able to resume their normal activity immediately. You can expect some swelling, bruising, or redness at both the donor and recipient sites. The severity of these symptoms depends on the size and location of the treated area, as well as the extent of liposuction at the donor site. The swelling and puffiness at the recipient site may last several weeks, especially if a large area was treated. You should stay out of the sun until the redness and bruising subsides – usually 3 days. In the meantime, you may use makeup with sun-block to conceal any signs of your procedure.
The duration of effects of the fat injection varies from patient to patient. Though some patients have reported results lasting over several years, the majority of patients notice some decrease in fullness within the first 6 months.
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What is Breast Augmentation?
Breast enhancement or augmentation is one of the most frequently performed cosmetic procedures in the United States today. It can dramatically improve the appearance of a woman's breasts. This procedure is used to enlarge small or enderdeveloped breasts. A lift procedure could be added in cases where volume loss and ptosis occurs (following pregnancy and delivery).
The following information was assembled for our patients to help them make a well informed decision about their surgery.
Is breast augmentation for you ?
It is of paramount importance to discuss all your goals and expectations with your surgeon. Your breast shape ,diameter ,degree of ptosis,symmetry etc.. will be assessed during the consultation. The following important points should be addressed by your surgeon:
1-Implant size that would fit your body.
2-Different incisions to access your breast .
3-Types of implants available.
4-Location of the implant.
5-Post-operative course and down time.
6-Effect of surgery on nipple sensation and future nursing.
7-Safety and adverse effects of the procedure.
Finally your consultation will proceed into trying different implants, reviewing different pre and post operative results as well as taking pictures and performing a digital analysis of your own chest and breast shapes.
Conclusion:
Breast augmentation mammoplasty is a safe procedure that has produced pleasing and satisfying results for many women. Those who are psychologically stable and have realistic expectations benefit the most. A preliminary consultation can help you determine whether breast augmentation is right for you.
References:
1-The American society of plastic surgeons.
2-The American Society for aesthetic plastic surgery.
3-Hisham Seify, MD; T. Roderick Hester, MD. "Preliminary (3 Years) experience with Smooth-wall Silicone Gel Implants for Primary breast augmentation" Annals of plastic surgery March 2005
4- Frank Elliott M.D, Hisham Seify M.D Avoidance and Management of Complications: Tissue Expanders in Breast Surgery. Innovations in Plastic Surgery. September 2005.
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What are the Breast Lift and Breast Reduction Procedures?
The decision to have a Breast reduction or lift procedure could be a life affirming one. Wheterher it is done for neck pain, shoulder pain,inability to engage in many physical activities or just for cosmetic reason both procedures are associated with high patients satisfaction . Most women who pursue breast reduction consider the procedure for many years before having surgery, and they often wonder why they waited so long to undergo such a life changing operation.
Extremely large or droopy breasts may be the result of excessive development or the aging process. Such changes most frequently occur for hereditary reasons during menarche, pregnancy or following menopause; or at any time during a woman's life as a result of weight gain.
Extremely large or droopy breasts may be the result of excessive development or the aging process. Such changes most frequently occur for hereditary reasons during menarche, pregnancy or following menopause; or at any time during a woman's life as a result of weight gain.
Although the goals of breast reduction and breast uplift procedures are different, the pre-operative preparation, surgical incision, and postoperative course are quite similar. In both procedures, incisions are designed to create a more youthful and natural shaped breast. In both procedures, this involves elevating the nipple/areola complex to a more natural position on the center of the breast mound.
During your consultation at Newport Plastic Surgery, Your Plastic Surgeon will access the degree of breast ptosis, skin quality, nipple location etc…
During your consultation at Newport Plastic Surgery, Your Plastic Surgeon will access the degree of breast ptosis, skin quality, nipple location etc…
Different techniques and incisions will be presented to you. Pre and post operative of some of our patients will be reviewed. Finally your surgeon will discuss risks, alternatives and post-operative recovery.
Conclusion:
Breast reduction/breast lift is highly technical procedure that is associated with high patient satisfaction. A pre-requisite for a good outcome is a well informed realistic patient together with a well qualified surgeon.
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What is Gynecomastia, or Male Breast Reduction?
Gynecomastia is a medical term that originates from the Greek words for "women-like breasts." This condition is far more common than many realize. Gynecomastia affects an estimated 40 to 60 percent of the male population. It may affect only one breast or both. Although certain drugs such as anabolic steroids, medications containing estrogen, alcohol, marijuana, etc., and medical conditions including cancer, impaired liver function, to name a few, may cause or contribute to enlarged male breasts, it is widely accepted that a large percentage of cases derive from unknown sources.
Men of any age who are healthy and emotionally stable are considered good candidates for male breast reduction surgery. The best candidates are those who have firm, elastic skin that will reshape to the body’s new contours. In some instances, surgery may be discouraged for overweight men who have not first tried an exercise and diet regimen.
Enlarged male breasts can be reduced by liposuction and/or by cutting out excess glandular tissue. The procedure for male breast reduction takes an average of two hours, usually on an outpatient basis, using general or local anesthesia. If excessive glandular tissue, fat and skin is present, it will be removed.
Surgery may be performed alone or in conjunction with lipoplasty, where the suction device will typically be inserted through the existing incisions. For the removal of excess fatty tissue alone, liposuction may be all that is needed; in such cases, scars will be small and barely visible.
Results are permanent, although subsequent obesity can create a gynecomastia-like effect. Some of the benefits of surgery include a firmer, flatter, more contoured chest which may give the male patient a boost in self-confidence. There is little downtime, and you may return to work within one week usually, unless you are involved in strenuous activities.
There will be scarring around the nipple of the breast (areola) from this procedure but will fade over a period of time and be less visible. There will be some post-operative bruising, swelling, and burning sensation. To assist with the healing process, the patient will wear an elastic pressure garment for 3-6 weeks and must avoid exposing scarred areas to the sun for at least 6 months.
Other considerations include temporary numbness or lack of sensation that could last up to a year. Infrequent complications may include infection, skin damage, fluid accumulation, bleeding, scarring or pigment changes. Post-operative asymmetry, while rare, is possible; a second procedure may be needed to remove additional tissue.
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What Body Contouring Options are There for Post-Bariatric Patients?
Post bariatric surgery reconstruction emerged as new subspecialty of plastic surgery in the last few years. This constitutes a group of procedures that are utilized to tighten excessively loose skin, frequently after massive weight loss. A smaller group of patients, who are normal weight and have never been overweight, will present with loose enough skin to warrant surgical tightening in the inner arm, posterior trunk, buttocks or thigh regions.
Abdominoplasty, or a "tummy tuck," is designed to correct a protruding abdomen resulting from weak abdominal muscles, weight gain or pregnancy. Obesity and aging cause the skin to lose its elasticity. These conditions may not respond well to diet or exercise if the skin and underlying muscles have been stretched.
With abdominoplasty, the abdominal wall muscles are tightened and excess fatty tissue and skin are removed to improve the body contour. The goal is a narrower, flatter abdomen. Realistic expectations are important. Abdominoplasty is not a substitute for weight loss.
Your doctor considers age, obesity and smoking habits when evaluating a candidate for this procedure.
Before Surgery
We will take a complete medical history and conduct a careful examination to evaluate your general, overall health. Ideally, the abdominoplasty patient has no health problems, and wishes only to remove an excess deposit of fat or loose abdominal skin. Patients on a weight-loss plan should be close to their target weight before having the operation. Women planning future pregnancies should delay abdominoplasty, as pregnancy may promote further abdominal stretching.
Photographs will be taken before and after surgery.
Antibiotics will be prescribed prior to surgery to prevent infection. To minimize the possibility of excess bleeding, you will need to avoid taking drugs containing aspirin. You will also be advised to bathe with an antiseptic soap for several days prior to surgery.
The Procedure
Abdominoplasty is performed using general anesthesia. You may be given medication beforehand so you will feel relaxed. The surgery may take 2-5 hours, depending on your overall condition. You may be released after a few hours, or you may require a couple days of hospitalization.The procedure is most commonly performed by making a U-shaped incision below one hipbone, across the pubic area and under the other hipbone. A second incision is made around the navel. The skin is then separated from the abdominal wall and lifted up to the hipbone, exposing loose tissue covering the abdominal muscle.
Loose, stretched out muscles are tightened with sutures, and excess skin and fat are removed. The skin is lowered over the abdomen and the navel is reconstructed. The incisions are then sutured together. Drains are often inserted to eliminate fluid buildup, and firm elastic bandages are applied to the area.
Recovery: What to Expect
You may experience some discomfort immediately following surgery that can be controlled with pain pills. Some swelling is normal. You will be given special instructions for showering and changing your dressings until the surface stitches are removed in 5-7 days. You may also be required to wear a support garment.
The speed of recovery depends on your physical condition prior to surgery; those with stronger abdominal muscles usually recover faster. Allow at least 2-4 weeks to recuperate before returning to work.
Some scarring is also normal. It often takes 9-12 months before the scars begin to fade.
Though the recovery period is longer than that of other cosmetic procedures, the rewards are great for a patient previously distressed by a protruding abdomen. Those who follow a proper exercise routine and healthy diet will benefit from abdominoplasty the most.
Body lift, or belt lipectomy, is performed to remove the excess skin and fat that exists on the body as a result of age or extreme weight loss. The body lift is performed on the lower torso and upper legs and involves the belly, hips, back, buttocks and outer thighs. People who have excess skin or fat in all of these areas may benefit from the body lift procedure.
This procedure involves a tummy-tuck combined with a circumferential excision of excess tissue from around the entire trunk while elevating the buttock and outer thighs. Obviously, this is a very extensive procedure requiring longer operative times and recovery than just a tummy-tuck. A lifting effect is obtained at the level of the buttocks, the outer thighs as well the abdomen and flanks.
A thigh lift removes loose skin from the thighs. Weight loss is the usual cause of extensive redundancy of skin in the inner thigh area. Constant rubbing of this redundant inner thigh skin can result in irritation and infection. Appearance and comfort are improved by the thigh lift procedure.
This procedure involves resection of redundant tissue of the inner thigh using incisions that parallel the groin crease. The thigh lift is usually performed on the inner surface of the thighs but can include the outer thigh area and buttock if indicated.
An arm lift, or brachioplasty, is a procedure to remove excess fat and skin of the upper arm. Aging or weight loss can cause the upper arm skin to become loose and sagging. An arm lift serves to remove excess skin and fat which reduces the circumference of the upper arm. The extra skin and fat are removed through an incision along the inner aspect of the upper arm. This incision is placed in order to best tightened the tissue but the incision must also be well hidden.
Liposuction is a very common, popular procedure. It is designed for the permanent removal of fatty tissue, commonly referred to as “cellulite.” It is an elective procedure that allows the plastic surgeon to remove undesirable, subcutaneous fat in isolated areas that do not respond to diet and exercise. These areas include the hips, thighs, abdomen, knees, ankles, face, neck, and arms.
Liposuction is most successful in people with good skin tone who have fatty deposits. It is not a treatment for obesity. If weight gain occurs following liposuction, the fat will be deposited in areas that have not been treated. The procedure can be repeated, if necessary. To maintain the safety of the procedure, there is a limit on how much can be done at one time.
A variety of factors can affect the results: Physical condition, genetic makeup, diet, exercise, smoking, alcohol intake, and skin elasticity.
Body contours made irregular by fat can be improved by this procedure; it cannot correct contours that are irregular for other reasons, such as muscle weakness or hernia. However, combined with other procedures, liposuction can correct these other deformities with good results.
The Procedure
Liposuction is done under general anesthesia on an outpatient basis. The surgeon makes small (less than 1/2 inch), discreet incisions in the areas to be treated. A cannula is inserted in a small incision and attached to a suction machine. The procedure may take an hour or more, depending on how many areas are involved.
Recovery
Recovery from liposuction is relatively easy. Expect a fair amount of swelling and bruising in the following two weeks. You will wear special garments provided to apply pressure, minimize swelling and provide support while healing. These garments also assist in retraction of the skin. Stitches will be removed in a week to 10 days.
Results are recognizable almost immediately and will continue to improve as swelling subsides. The day after surgery you should be up and walking around. Increase your activity daily until full activity is resumed at 2-4 weeks. You will be ready to return to office work in 3-5 days and more active employment at 10-14 days. Avoid the sun until all bruising has subsided. A sunscreen should be used routinely; it is easy to get sunburned during recovery because of decreased sensation.
The results of liposuction are permanent. If you were to gain a large amount of weight you might note rippling in the treated areas, depending on your skin elasticity.
Possible Complications
As with any surgical procedure, complications can occur. Cosmetic complications include contour irregularities, skin discoloration, asymmetry, scar tissue, tape burns, collection of blood or fluid under the skin. Uncommon complications include loss of sensation, skin breakdown, fat embolism, serious infection or shock. Bleeding does occur during liposuction. There is a limit to the amount of fat that can be safely removed in a given procedure.
Following liposuction, the scar will go through a maturation process—during the first 8-12 weeks they may be red and possibly raised. The scars will mature over 6-2 months and become pale, flat and soft. You may experience numbness, burning, tingling around the incision site. These symptoms are almost always temporary.
Please let us know if you are prone to keloid scars.
Post weight loss patients also frequently are left with loose neck skin or jowls, and these procedures are covered in the face lift section. This section will focus on procedures utilized to address skin laxity along the inner arms, upper and mid back regions, buttocks and thighs.
Twenty five years ago, it was rare to have a patient walk into a plastic surgeon’s office after substantial weight loss. But these days, we routinely see patients who have lost in excess of one hundred pounds. About three quarters of the massive weight loss patients we see did so with the assistance of bariatric surgery – such procedures have been designed to either decrease the size of the stomach pouch or some variety of “bypass” which shunts food down the intestines quicker without absorbing as many calories. With the advent of laparoscopic surgery and the more sophisticated bypass and stapling techniques, the efficacy, safety and popularity of such “bariatric” surgery has sky rocketed. This year over 140,000 bariatric procedures will be performed in the United States, and the numbers keep climbing higher each year as more centers with expertise in such procedures open up. But a good quarter of the weight loss patients we see achieved their results the good old fashioned way, by altering their diets and by exercising regularly!
Most patients who have lost a lot of weight have multiple areas to address. These body contouring procedures can be combined to address multiple areas, with certain limitations and exceptions. It is not safe to address the inner thighs and abdomen at the same sitting because of blood flow interruption to the pubis and strip of skin between the inner thighplasty scars and abdominoplasty
Or belt lipectomy scars. But with either procedure, it would be safe to address, for example, the inner arms or breasts. Such procedures may also be combined with non-skin tightening operations such as liposuction, eyelid surgery or other procedures. Your overall health and age will also help determine how much surgery you can tolerate in one day. But even if you are in perfect health, it is unwise to electively schedule procedures that are designed to be longer than six hours in length because after that time, your chance of developing a blood clot in your legs or other complications will become more likely.
The operation is directed toward an improvement and will not in any way give you complete obliteration of all folds, laxity and stretch marks. You must accept the judgment of your plastic surgeon and realize that he will remove as much as is safe and suitable. Particularly in patients with thicker fatty layers or marked skin excess, it may be desirable to return for additional skin excisions to obtain an optimal result.
The type of skin, degree of elasticity and age of the patient all influence the overall result that is obtained. The operation should not be undertaken if the patient’s weight is not stable or if a patient has not made a commitment to themselves to keep the weight off in the foreseeable future. While it is not necessary for the patient to reach a certain weight before surgery may be performed, it is desirable that the patient's weight be stable for at least six months prior to surgery and that the patient be at a weight he/she feels can be maintained after the procedure.
A common question is, "How long will the results of this procedure last?" This is impossible to state. Factors affecting the length of the result include age at the time of operation, physical conditioning afterwards, type of skin, and alterations in weight. In general, it is not necessary to repeat these procedures after an optimal result has been achieved. Should the patient wish to repeat the operation, regardless of the length of time since the initial operation, the degree of laxity or fatty excess remaining, and each patient will be responsible for the cost of a subsequent procedure.
POST-OPERATIVE CARE:
Adequate pain medication will also be prescribed. All patients, who go home on the day of surgery or the next morning, will find that an assistant at home is a necessity for the first three days or so. High bulk foods are highly encouraged and laxatives may be necessary to prevent straining associated with constipation.
The patient will be encouraged to walk as much as possible at home after surgery as this will reduce the possibility of pneumonia or of clots forming in your calf veins. It will be necessary to avoid flexing the hips after thigh or buttocks procedures for the first few weeks to prevent excess tension on the suture lines.
The patient will usually be allowed to shower after the drains have been removed, but soaking in a bathtub is to be avoided for two weeks. Wounds are generally closed with buried sutures. The incisions are covered with surgical tapes, which are to stay in place for the first two weeks. These tapes will not fall off with gentle showering as long as you refrain from rubbing them with face cloths or towels.
Your first post-operative visit will generally be scheduled two to four days after surgery at which time the pain pump catheters will be removed, or four to six days later if you choose not to have the
pain pumps. The drainage tubes will be removed at a subsequent visit, when the drainage has essentially stopped. You will be required to have someone drive you to the office for your first, and perhaps second, visits. Most patients find that they can gradually increase their activity levels thereafter. You may drive a car with caution, wearing a safety belt, beginning 48 hours after your last pain pill or sedative, if you feel comfortable and physically able to do so.
SOCIAL ACTIVITY:
Social activity should be limited while the patient is uncomfortable. Lifting anything that causes discomfort should be limited for approximately four to six weeks to allow the tissues to heal properly. Strenuous activity should be avoided during the initial six to eight weeks. Basically, most patients find that they can return to normal activity as the discomfort of the operation fades away. Office work can usually be resumed within 1-2 weeks of surgery, but the patient should expect a six-week delay before returning to physical labor or strenuous exercise. It will take longer than a year for scars to fade and the abdomen to feel relatively normal. The lower abdominal skin may feel numb forever and completely normal feeling is not to be expected.
POSSIBLE COMPLICATIONS:
Serious complications after an abdominoplasty are relatively uncommon. However, there will be a long scar (usually, but not always, within the bathing suit line) extending from hip to hip. The scar may remain itchy, painful, thick, or otherwise unsightly. It is unusual, but possible, for areas of fat to liquefy and drain through the incision for many months. As with any abdominal procedure, it is also possible for a suture or staple to become infected and to erode through the skin years later.
Fat is poorly vascularized, does not have much tensile strength and does not contribute significantly to holding the wound together. In this type of surgery, particularly involving the trunk or lower extremities, there is a very high incidence of portions of the incisions pulling open. Occasionally the wound margins can be resutured, but frequently the safest course of action is to leave the wound open and allow it to heal by contraction and secondary intention. This might take a few months to occur and may necessitate wound care at home from a visiting nurse. Should this occur, it may be necessary to perform a secondary scar revision a year or so later. As with all complications or desired secondary procedures, each patient will be responsible for the cost of a subsequent care or procedures.
It is common to experience swelling of the hands with a brachioplasty, or of the ankles following thigh or buttocks surgery. Such swelling is self limiting. Some areas of numbness will be evident following body contouring surgery. Usually, most of the feeling will return within about a year but some patients will experience areas of permanent numbness.
One of the most common problems after body contouring is a persistent collection of serous fluid under your skin after the drains have been removed. Should this occur, this fluid will be aspirated by your surgeon with a needle during your post-operative visits. Such drainage always stops eventually (but may persist for more than a month) and usually does not affect the final results. If wound problems develop, it may take several weeks or even months for healing to take place and the patient will be required to wear dressings over the open wound. Because of the extensive skin
And fat undermining, areas of skin may die and slough, or even require surgical debridement or a skin graft. Rarely, phlebitis may develop in leg veins and even more rarely, blood clots could travel to the lungs, potentially leading to a fatal complication.
Perfect symmetry does not exist before or after body contouring surgery. Scars will never be identical from side to side. As mentioned earlier, it will take longer than a year for scars to fade.
Secondary procedures may occasionally be desirable to revise scars or to remove additional tissues. The patient will be responsible for all costs associated with secondary surgical procedures.
It is not possible to list every conceivable complication. As with any operation, there could be potential complications, which could even be fatal. The foregoing is not intended to frighten or upset you but to enable you to make your decision with an understanding of some of the involved risks.
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What is Liposuction?
Liposuction is a cosmetic surgery operation that helps sculpt the body by removing fat from specific areas like the abdomen, hips, buttocks, thighs, knees, upper arms, chin, cheeks, and neck. The fat is usually removed through a cannula (a hollow tube) and aspirator (a suction device). Liposuction is not a substitute for dieting and exercise, but it can remove stubborn areas of fat that do not respond to traditional weight loss methods.
Best candidates for liposuction: The best candidates for liposuction are people who are near their ideal weight and have firm, elastic skin with pockets of excess fat in certain areas. You should be physically healthy and realistic with your expectations. Individuals with certain medical conditions may not be suitable candidates for liposuction.
Anesthesia for liposuction: Your surgeon will select the type of anesthesia that is most suitable and safe for your surgery. If only a small amount of fat and a limited number of areas are involved, liposuction can be performed under local or twilight anesthesia, which numbs only the affected areas. General anesthesia is a good choice for more extensive procedures. In such cases the anesthesiologist makes sure you are completely asleep during the procedure.
Anesthesia for liposuction: Your surgeon will select the type of anesthesia that is most suitable and safe for your surgery. If only a small amount of fat and a limited number of areas are involved, liposuction can be performed under local or twilight anesthesia, which numbs only the affected areas. General anesthesia is a good choice for more extensive procedures. In such cases the anesthesiologist makes sure you are completely asleep during the procedure.
Preparing for surgery: Patients should stop taking anticoagulants for two weeks prior to surgery. Smoking must be avoided for at least one month prior to surgery as it can interfere with circulation and causes blood clots.
The surgery: The time required to perform liposuction varies considerably, depending on the size of the area, the amount of fat being removed, the type of anesthesia and techniques used. Through a tiny incision, a narrow tube is inserted and used to vacuum the fat layer that lies deep beneath the skin. The cannula is then pushed and pulled through the fat layer, breaking up the fat cells and suctioning them out by a vacuum pump or a large syringe. The fluid lost along with the fat is replaced during the procedure to prevent shock. The patient is under careful observation throughout the procedure and receives intravenous fluids during and immediately after surgery.
Techniques used in liposuction: The basic technique of liposuction as described above is used in all patients undergoing this procedure. A medicated solution is normally injected into the fatty areas before the fat is removed. The fluid is a mixture of intravenous salt solution, lidocaine (a local anesthetic) and epinephrine (a drug that contracts blood vessels) in order to help the fat to be removed easily, reduces blood loss and provides anesthesia during and after surgery.
The surgery: The time required to perform liposuction varies considerably, depending on the size of the area, the amount of fat being removed, the type of anesthesia and techniques used. Through a tiny incision, a narrow tube is inserted and used to vacuum the fat layer that lies deep beneath the skin. The cannula is then pushed and pulled through the fat layer, breaking up the fat cells and suctioning them out by a vacuum pump or a large syringe. The fluid lost along with the fat is replaced during the procedure to prevent shock. The patient is under careful observation throughout the procedure and receives intravenous fluids during and immediately after surgery.
Tumescent technique: Large amount of fluids ( three times the amount of fat to be removed ) are injected in this technique. The technique is performed on patients who need only a local anesthetic. The procedure takes 4 to 5 hours.
The super-wet technique: In this technique, lesser amounts of fluids are used. Usually the amount of fluid injected is equal to the amount of fat to be removed. It is performed under general anesthesia and takes one or two hours of surgery time.
Ultrasound-assisted liposuction: This technique uses a special cannula that produces ultrasound energy. As the cannula passes through the fat areas, the energy ruptures the fat cell walls which then liquefies the fat. The fat is removed by a suction pump. The fibrous areas of the body like the upper back or enlarged male breasts can be treated effectively with this type of technique.
Recovery: To control swelling a compression garment will be worn for several weeks. Your doctor will prescribe antibiotics to prevent infection. You may experience some initial discomfort, swelling, and temporary numbness. All of this will subside with time; depending on the amount of liposuction, normal activity can be resumed anywhere from 10 days to several weeks.
Precautionary measures to be taken: Healing will be a gradual process. You should start walking around to reduce swelling and to help prevent blood clots from forming in your legs. Drink sufficient water to avoid dehydration. Avoid alcohol for a few days. Avoid submerging in bathtubs or swimming pools. More strenuous activity should be avoided for several weeks to a month, as your body continues to heal. By eating a healthy diet and getting regular exercise, you will help maintain your new shape.
Possible complications:
Though the complications are rare, they can occur. The risks are higher when treated areas are very large or large amounts of fat is removed.
- Infection at the punctured site and delay in healing.
- Damage to skin, to avoid wounding the skin the surgeon works at deeper levels of fat.
- The formation of fat clots or blood clots, which may migrate to the lungs and cause death.
- Excessive fluid loss, which leads to shock.
- Fluid accumulation which has to be drained.
- Friction burns or either damage to the skin or nerves of performance injury to the vital organs.
- Unfavorable drug reaction.
- Skin necrosis is a rare complication in which skin falls off in necrotic area and results in bacteria invasion.
- Lidocaine toxicity.
- In super-wet techniques, too much saline fluids are injected which contain high concentration of lidocaine which become too high for that particularly person's system.
- The skin may be irregular asymmetric or even "baggy" especially in older patients.
- Numbness and pigmentation may occur.
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What is the Abdominoplasty, or Tummy Tuck?
Abdominoplasty, also known as a Tummy Tuck, removes loose hanging abdominal skin and tightens weakened abdominal wall muscles. Because even diligent diet and exercise cannot fix these problems, each year more than 80,000 American women and men undergo tummy tuck surgery. Women and men who have a protruding belly, loose hanging abdominal skin and weak abdominal muscles are candidates for a full tummy tuck.
Mini-Abdominoplasty, also known as a Mini-Tummy Tuck, is reserved for those who have only a limited amount of loose skin or stretch marks in the lower abdomen, or above the public bone. Also, Mini Tummy Tuck does not usually involve the tightening of abdominal muscles. Therefore, it is sometimes combined with Liposuction for patients with excessive fat, but limited looseness of the abdomen.
In most cases, women considering abdominoplasty should not be considering additional pregnancies, or they may have the need for a second procedure to re-tighten the belly. In many cases, a tummy tuck does help rid of stretch marks because it removes most of the "stretched out" skin below the navel.
The umbilicus or "belly button" is disconnected from the abdomen, and reattached after the loose skin is removed. A skilled plastic surgeon not only tightens the abdominal wall, but also pulls up and tightens the thighs and the buttocks. Drains will be inserted into each side of your abdomen to remove excess fluid as it accumulates following surgery.
During Mini-Abdominoplasty, the plastic surgeon makes an incision that generally spans only the width of the pubic area, and that is similar to a C-section incision. In both procedures, patients with excessive fat in the hips and flanks may have liposuction in these areas to contour them, but not in the areas of the abdomen that are being stretched because this could cause damage to the blood circulation in those areas, leading to scarring or even skin loss. The result of a tummy tuck is an abdomen that is tight and flat, a waist that is narrow and curvy and thighs and buttocks that are firmer.
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