As a Female Plastic Surgeon, no one understands better the challanges, goals, and aesthetic details of the female body.
WHAT IS LIPOSUCTION?
Liposuction is a cosmetic surgical procedure for both Men and Women which permanently removes fat from areas such as the neck, arms, abdomen and thighs. It is also a tool that is used to “sculpt” certain areas such as the chest or abdomen to help enhance the underlying musculature. It is an outpatient procedure that can be done with varying levels of anesthesia depending on the number and location of the areas performed. Though the fat is permanently removed, maintaining results with a healthy diet and exercise routine postoperatively is key to long lasting results.
AM I A GOOD CANDIDATE?
The best candidates for liposuction are in overall good health, maintain a healthy and stable weight, and are motivated to maintain their aesthetic results after surgery. Because liposuction alone will not tighten loose skin, ideal candidates do not have significant skin laxity. If there is significant skin laxity present, then combining liposuction with a skin excision procedure such as a Tummy Tuck is most appropriate.
During the procedure, multiple small incisions (3 to 4 mm) are created within camouflaged areas such as the groin creases or belly button. First, a Tumescent solution is injected into the areas. The Tumescent solution is a combination of Saline, Lidocaine and Epinephrine to help facilitate fat removal, decrease bleeding and provide postoperative pain control. After this step, small liposuction cannulas are inserted through the incisions in order to remove the fat. It is important to continually monitor the skin for uniform thickness and overall contour. Once the optimal contour has been achieved, the incisions are closed with a simple, dissolvable suture. Patients are placed in a compression garment after surgery which they will wear for upwards of two months to achieve the best surgical results. Results from liposuction take time and patience is critical. Dr. Megan generally tells her patients that five or six months is needed in order to see final results.
After surgery has been completed and the patient has been placed in a compression garment, they are then discharged home for recovery. We encourage all our patients to be up and moving around after surgery in order to help mobilize fluid and prevent blood clots in the legs. Patients will be provided with compression stockings. Patients remain in their postoperative compression garments until the first postoperative visit. The first 2-3 days after surgery patients will notice drainage from their incisions sites-- this is normal and is due to the tumescent solution that was added to the tissue prior to fat removal. Patients generally require pain medication for the first couple of days after surgery and the average time off work is approximately one week.
WHEN WILL I SEE MY RESULTS?
Final results after liposuction can take upwards of 5 to 6 months. The process of removing fat creates lots of swelling. Even more, when we are performing fine, detailed Lipo Sculpting, we must have even more patience to await our results as even a couple of millimeters of swelling will temporarily alter the final contour. Result maintenance with diet exercise and overall patient lifestyle is critical to maintaining liposuction results. While the fat cells removed during liposuction will never grow back, the fat cells that remain can get bigger.
TUMMY TUCK (ABDOMINOPLASTY)
WHAT IS A TUMMY TUCK?
A Tummy Tuck, or an Abdominoplasty, is a cosmetic procedure aimed at removing loose, stretched out abdominal skin, reshaping and tightening the waist, and removing stubborn fat. As we age, with pregnancy, or with weight loss and weight gain, the skin of the abdominal wall stretches out but rarely re-tightens. In addition, we tend to gain that extra, stubborn “fluff” around the abdomen. While diet and exercise are important for a healthy routine, they often do little to tighten the skin, decrease stretch marks or shrink the waist. An Abdominoplasty is a 3-Dimensional procedure aimed at restoring the aesthetics of all the layers of the abdomen. The innermost “core” can be reconstructed by moving the Rectus Muscles (vertical ab muscles) back to their midline position. This is called a Diastasis Repair. The intervening fat layer can be liposuctioned, and the outermost skin is removed and tightened.
AM I A GOOD CANDIDATE?
The ideal candidates for a Tummy Tuck are in good overall health and are at a stable and healthy weight. For weight loss patients, this procedure is most optimally placed at the end of their weight loss journey. We recommend that women wait until they are done having children before undergoing a Tummy Tuck. Patients with a history of blood clots or who have multiple risk factors for blood clots after surgery may be required to take a blood thinner after surgery.
A CLOSER LOOK:
A careful evaluation of the trunk as a whole must be done in order to assess which areas will need to be addressed during surgery. We look at how much and where any loose or excess skin is, the location and extent of fat deposits and if the Rectus muscles are in their ideal, midline position. There are multiple variations of a Tummy Tuck that can be tailored to meet each individual patient’s anatomy and goals:
Mini Tummy Tuck: This procedure uses a shorter scar just above the pubic bone to remove loose skin of the LOWER abdomen only. It does not tighten skin above the level of the belly button and is best suited for patients who have isolated skin laxity and stretch marks below the belly button. Liposuction can be added for additional sculpting and the Rectus muscles below the belly button can be addressed but not above.
Traditional Tummy Tuck: A “Traditional” Tummy Tuck is best suited for patients whose main issue is the loose, stretched out skin of the abdomen. In this variation, liposuction of the waist can be performed and the Rectus muscles can be tightened. All loose skin below the belly button is removed and the incision is placed just above the pubic bone where it can be hidden by a bikini or underwear. The belly button remains attached to the underlying muscle layer but a new hole must be made for it once the skin has been redraped.
Lipoabdominoplasty: This technique combines a the skin excision of a Traditional Tummy Tuck with Liposuction to not only remove extra skin but also thin out the fat layer on the front of the abdomen. All loose skin below the belly button is removed and the incision is placed just above the pubic bone where it can be hidden by a bikini or underwear. The belly button remains attached to the underlying muscle layer but a new hole must be made for it once the skin has been redraped.
An Abdominoplasty is safely performed as an outpatient procedure in our State-of-the-Art Surgical Facility. The procedure requires a general anesthesia to perform, and can be completed in under 3 hours. It is often combined with other procedures such as Liposuction or Breast Surgery as is often the case in a Mommy Makeover.
The patient will be marked the morning of surgery for the areas of fat to be removed and the baggy, excess skin to be excised. Once asleep in the operating room, any Liposuction is performed first. An incision is then made around the belly button and horizontally above the pubic bone. The length of the lower incision is dependent on how much skin will need to be removed. The more skin, the longer the incision. The abdominal skin is then elevated up to the level of the rib cage so it can be optimally redraped. The incision is then closed with multiple layers of absorbable stitches for strength. Drains are rarely used but Dr. Megan always tells her patients they are possible. The final part of the procedure is the inset of the belly button. The patient is then placed in a compression garment and will eventually be discharged home to recover.
AFTER SURGERY: Patients are encouraged to be up and walking immediately after surgery. They will remain in their initial compression garments until the first postoperative visit. If no Liposuction is performed, they may discontinue abdominal compression at one week. When Liposuction is performed, long term compression is recommended for at least two months after surgery. The abdomen will feel very tight and sore initially such that patients often hunch over for the first couple of days after surgery. As the swelling goes down, patients will begin to feel more comfortable standing completely upright. The patient is restricted to lifting over twenty pounds (ten pounds per side) for four weeks. Activity can be increased over the weeks after surgery based on the approval of Dr. Megan. Dedicated core exercise should wait until at least six to eight weeks after surgery.
Many patients seeking a Tummy Tuck have young children at home. It is important to consider the weight lifting restrictions after surgery in determining the optimal time to pursue this procedure.
ARM LIFT (BRACHIOPLASTY)
WHAT IS AN ARM LIFT?
An Arm Lift (Brachioplasty) is a cosmetic procedure to remove the loose, flabby skin on the inner and posterior aspect of the upper arms. As we age or with weight fluctuations, the skin stretches out and cannot be tightened with diet and exercise alone. This area in particular is a source of insecurity for many patients as this loose skin is very visible with short sleeved shirts or tank tops. There are often extra fat deposits on the back of the arm as well, which can be liposuctioned simultaneously during an arm lift. The incision is hidden on the inner aspect of the arms and not visible from a frontal view.
AM I A GOOD CANDIDATE?
The ideal candidate for an Arm Lift is somebody who is in good overall health with a relatively stable weight. If the patient has undergone a massive weight loss, they may require blood work prior to surgery to ensure they have the nutritional capacity to heal properly.
An arm lift can be done alone or in combination with other surgical procedures. The surgery can safely be done in our Ambulatory Surgery Center as an outpatient procedure. Patients will undergo a general anesthetic by our outstanding team of Anesthesia Providers. The arms are marked prior to surgery to ensure the appropriate amount of skin is removed. The final incision will be placed near the bicipital groove on the inner aspect of the arm and generally runs from above the elbow to the armpit or even onto the chest wall depending on how much extra skin is present.
Once in the operating room and asleep, Tumescent Fluid is injected into the upper arms. Liposuction is first performed not only to remove extra fat but also to facilitate the surgical dissection. Careful excision of the excess tissue is then completed to ensure a smooth, uniform contour. All stitches are placed under the skin and are dissolvable. Surgical tape is placed over the incisions. After surgery the arms are wrapped in ACE bandages for compression. The patient is discharged home to recover.
After surgery the patient will be restricted to no lifting over 10 pounds and no arms above the head for 4 weeks to protect the incisions. Especially in an Arm Lift, the incisions are prone to widening so great care must be taken to avoid excessive tension during the initial healing period. Compression bandages will be worn for the first 2 weeks after surgery or longer if the patient desires. Scar care will generally be initiated 2-3 weeks after surgery once the surgical tape has been removed.
WHAT IS A THIGH LIFT?
As we age or after weight loss, the inner thighs can develop loose, flabby skin that diet and exercise alone cannot tighten. A Thigh Lift is a plastic surgery procedure to directly remove excess skin on the inner aspect of the thighs to create a smoother, sleeker appearance. It is often combined with Liposuction to address any bulk of the inner aspect of the thighs, and can safely be performed with other surgical Body Contouring Procedures such as a Tummy Tuck or Body Lift.
AM I A GOOD CANDIDATE?
The ideal candidate for a Thigh Lift is in good overall health and at a healthy, stable weight. If this procedure is part of body contouring after Massive Weight Loss, then a patient should be at their goal weight or close to it for 6-12 months and have optimum nutrition prior to undergoing surgery to ensure proper wound healing.
How a Thigh Lift is performed is dependent on how much loose skin is present. Some patients have only a mild amount of loose skin high up on the inner thighs. In these cases, a horizontal incision placed along the groin creases (Spiral Thigh Lift) will be sufficient in order to reshape and contour the inner thighs. Many patients, however, have too much loose skin for a shorter, horizontal incision and will require an incision that is placed on the inner aspect of the thighs in a vertical direction (Vertical Thigh Lift). This incision, though longer and more visible, is often required in order to obtain the optimal shape of the thighs.
The procedure can be safely performed in an outpatient setting under a general anesthetic. It takes 1-2 hours to perform and is often combined with other skin tightening procedures. A patient is first marked in the preoperative area for the amount of skin to be removed. It is important to avoid trying to remove too much skin as this can actually create a “shark bite” appearance. Once asleep in the operating room, Liposuction is often performed as the first stage to remove extra fat and assist with the surgical dissection. The marked skin is then directly removed, and dissolvable sutures are placed in a layered fashion underneath the skin. In some cases, drains may be used. Compression with an ACE bandage or compression garment will be used after surgery to help with postoperative swelling. Patients are then discharged home to recover.
Postoperative recovery after a Thigh Lift involves a combination of leg elevation and compression to help combat the natural process of swelling. Avoiding tension along the incisions by limiting activity will help to prevent scar widening. Patients take on average 5-7 days off work depending on the nature of their work.
Many women have insecurities about the appearance of their Labia. These insecurities can make it difficult to feel comfortable wearing certain clothing or bathing suites, or in times of intimate situations. Excess labial tissue can also make exercise or sexual intercourse physically uncomfortable. With age, childbirth, genetics or trauma, the Labia Minora (the inner lips of the Vaginal area) can elongate or stretch. A Labiaplasty is a plastic surgery procedure to remove extra, redundant tissue of the labia minora, and create a smooth, symmetric appearance. While these insecurities can be difficult to discuss, as a female plastic surgeon Dr. Megan provides a comfortable environment for her female patients to openly learn about their options.
AM I A GOOD CANDIDATE:
Good candidates for Labiaplasty are healthy, non-smokers seeking to improve the appearance of their female genitalia.
A Labiaplasty can be safely performed in an outpatient setting using IV or oral sedation combined with a Local Anesthetic. Once the patient is comfortable, numbing medicine is injected along the proposed incision line to help prevent bleeding and bruising and improve postoperative comfort. The extra tissue is trimmed and stitches are placed below the skin surface. The patient will be given a pad for any immediate bleeding after surgery.
After surgery, patients will be discharged home to recover. As you can imagine, this area is very sensitive during recovery and activity modifications are needed to ensure a proper recovery and healing. Much like after a perineal tear during labor, going to the bathroom may cause discomfort. It is recommended that patients purchase a Peri-bottle for this. Pads may be needed to line the underwear in the first days after surgery. Most patients will need a few days off work to recover and feel fully recovered in a number of weeks.