Tag Archives: coolsculpting

What is a reverse abdominoplasty, and who needs it?

Reshaping the contour of the abdomen is frequently requested in my office consultations. The most common techniques are various forms of liposuction with or without an abdominoplasty. Another tool in our repertoire which can yield effective results is the “Reverse Abdominoplasty.” The classic indications for a regular abdominoplasty is a torso which has loose excess inelastic skin of the lower abdomen, abdominal wall rectus muscle separation (diastasis), and varying degrees of excess fatty tissue. The technique eliminates the excess skin and fatty tissue in the lower abdomen, reconnects the rectus muscle together to tighten the abdominal wall, and excess abdominal fatty tissue can be reshaped with liposuction to provide a pleasing shape. A Reverse Abdominoplasty is chosen for the individual who has loose excess skin in the upper abdomen, who generally does not have a full diastasis which is affecting the lower abdominal contour, and may have excess fatty tissue in the lower abdomen without skin excess. The technique is to start with incisions that follow the lower breast fold then cross the lower sternum to connect both sides of the abdomen. These scars generally hide very well even in two piece bathing suites. The full thickness skin is elevated down the abdomen preserving the vital blood supply on either side of the belly button. If upper rectus muscles need to be tightened this can proceed. Any abdominal fatty excess can also be corrected with liposuction at this time. The elevated released excess abdominal skin can be addressed in several ways depending on the needs of the patient:

1. If a women who has the upper abdominal skin excess and also desires rejuvenation of the breast the excess elevated skin of the abdomen can be utilized as a self-augmentation under the breast to provide added fullness and shape. This is often done in conjunction with a breast lift (Mastopexy) and can avoid the need and expense of an implant. I have even performed this procedure with a woman who many years ago had bilateral mastectomies for breast cancer and we reconstructed her with implants. She had experienced some weight fluctuation and was becoming very active and requested the elimination of her breast implants but still desired a smaller breast to remain. We utilized a reverse abdominoplasty skin excess, removed the outer skin, and placed it in her implant space to fill the void and added tissue volume and shape provided with fat grafting harvested from her back, thighs, and lower abdomen giving her a smaller but still reasonable breast shape.

2. The Reverse Abdominoplasty could be incorporated as part of a treatment plan to tighten the upper abdominal contour. After the incision and elevation of the abdominal excess loose skin, the surgeon can remove the undesirable portion and fixate the remaining tissue to the rib fascia of the lower breast fold to avoid the scars from migrating inferiorly thus preventing the exposure of the scars on the upper abdomen. I have used this as a primary surgical procedure for women with loose skin of the upper abdomen that would not respond favorably to liposuction alone. I have also used this as a secondary procedure on women who have previously had an abdominoplasty with good results but over time the lower abdomen has maintained its results yet the upper abdomen has become loose and has excess as a result of weight changes, sun exposure, and of course gravity. The excess skin can be removed providing a nice tight appearance to the whole abdomen.

3. Another situation for the reverse abdominoplasty is for a women with loose upper abdominal skin combined with previous augmentation mammoplasty in which the implants have become mal-posed and have drifted inferior and lateral to the correct position. In this case the excess elevated tissue can be utilized as a autologous (meaning from your own body) soft tissue sling to help reposition and stabilize the implant similar to an Acellular Dermal Matrix (ADM) graft without the significant added cost of the product to provide long lasting results.

One of the aspects in my profession of plastic surgery I am most proud of is the innovative nature of the field. We take problem sets that patients present to our office and we create unique methods that achieve a sound result with the least amount of surgery and the lowest costs to ensure successful and happy patients. The Reverse abdominoplasty is an example of one of these off shoot procedures which fills a vital niche in my practice.

Jay H. Lucas, MD
Board Certified Plastic Surgery, MOC 2012
The Lucas Center, Plastic Surgery
Knoxville, Tn.
thelucascenter.com

Worried about skin rolls around your bra line?
We got your back.

Skin

Many women are uncomfortable wearing form-fitting clothes, because the skin either above or below the bra line creates rolls detracting from the aesthetics of the female back. Unfortunately this can occur at any age. Spanx may hide the problem, but who wants to wear tight undergarments during warm weather months?

Causes: The skin of the back and shoulder must accommodate the wide range of motion of the shoulder girdle. When the arms are raised above the head, the skin in the posterior upper armpit region must stretch to avoid restricting this movement. Over time our skin begins to enlarge and increase in surface area, particularly in the posterior-axillary fold region tapering towards the tip of the shoulder blade. The skin lower in the armpit region and sides along the ribs does not require expansion, but a transitional line or fold can develop and become more pronounced with gravity causing a landslide effect of the skin above. The appearance is made worse with a restrictive band of the bra traversing this region thus forming the dreaded “bra strap fat roll.”

Anatomy varies greatly depending on skin type and quality, body mass index (BMI), and age. In some cases, skin folds are very tight without a great deal of excess fat, but the skin excess is the issue. People with greater BMI scores may have a great deal of fat deposited in this region. The other extreme is the massive weight-loss patient who has very little adiposity but has a great deal of inelastic deflated skin, which hangs over the bra. Each of these types of patients requires different treatments to achieve a pleasing result.

Treatment options: If you have slight increases in fat deposits in your back with deep tight folds, the treatment of choice is suction-assisted lipectomy with the added energy source of either VASER-assisted suction lipectomy (ultrasonic energy), power-assisted suction lipectomy (PAL), which is a mechanical rotating blade effect built into the cannula, or HydraSolve, a heat and water pulsing technique that breaks down interstitial fibers surrounding the fat. All these approaches work by breaking down the ligamentous attachments between the back and the dermis of the skin combined with the inflammatory reaction of the surgical cannulas allowing a re-draping/redistribution of skin to tighten over the back and conform to the new contour.

In my opinion, the results of these techniques are superior to liposuction alone. Non-invasive body-contouring procedures such as cryolipolysis (CoolSculpting) have no mechanism to break down the fibrous insertions to the skin from the deeper fascia, thus no elimination of the tight fold lines will occur.

If you have an elevated BMI and increased adiposity of skin folds, you will also benefit from the above-mentioned techniques of added energy sources with liposuction, but a greater degree of fat removal is necessary. Increased fat volume requires a more cell removal. However, discretion must be utilized to prevent over resection that can result in loose hanging skin on the back.

For the massive weight-loss patient or the person who has a large amount of loose-hanging skin with or without added fat volume, a skin resection technique is often incorporated with a brachioplasty to correct hanging skin of the upper arms as well. My incision choice is a vertical resection of skin along the posterior axillary line angle, which is easily concealed.

If bra line skin or fat excess is detracting from the overall aesthetics of your back, you need a board-certified plastic surgeon to thoroughly evaluate your situation to determine the right treatment option to feel more confident in your own skin. Visit thelucascenter.com or call 865.218.6210 to schedule your personal consultation with me.

Consider custom solutions for a sagging neckline

neck-blog

Consider custom solutions for a sagging neckline

Necklines for both men and women can be a focal point of self-consciousness. However, the etiology of an unattractive neckline can be diverse, so treatment options must be tailored to the underlying cause. There is no one solution for everybody. Careful three-dimensional analysis of the soft tissue and underlying bony structure of the midface, lower jaw and neck are imperative to choosing the correct modality to improve your neckline.

Some common underlying causes of poor aesthetic necklines:

Small lower jaw – If you have a deep underbite despite orthodontics and a short chin, this leads to less bone support of the soft tissues of the jawline and submental region. People with this type of lower jaw may have a very obtuse chin-neck angle leading to redundant skin. An ideal treatment for this situation is bony chin advancement (genioplasty).
If your chin is horizontally too short, then an augmentation with a chin implant is an excellent choice. I prefer the Medpore implant, which is carvable, and screw fixated and becomes an extension of the bone.

Both genioplasty and chin implants can easily incorporate the technique of liposuction as a means of sculpting the soft tissues of the neckline by removing unwanted fat. Liposuction induces collagen production and facilities skin shrinkage and redistribution yielding a pleasing result. This combination therapy can produce a wonderful outcome that makes you look more facially balanced. However, if your skin is too loose and hanging, a more formal neck lift may be preferable to liposuction.

Mid face descent of soft tissues – Aging can affect facial fat compartments leading to decreased volume, which results in the midface falling over time. This sagging increases nasolabial folds and causes lower facial soft tissue to drape over the jawline. A crisper jawline can be restored by replacing missing soft tissue volume in the fat compartments of the midface with filler agents like Voluma and Sculptra or via fat grafting. Subtle volume enhancements can create a nice effect on the jawline without looking like you’ve undergone a surgical procedure.

Gravitational changes to the soft tissue of the neck – Gravity affects all of us. The skin and muscles of the anterior neck begin to pull away over time. The appearance of the platysma muscle medial bellies becomes apparent leading to unsightly banding. In the early stages of gravity-induced changes, treatments such as chemical peels, micro-needling and radio frequency can yield improvements and delay the inevitable soft-tissue sagging.
Ultimately the best treatment option is a face/neck lift. A well performed facelift by an experienced board-certified plastic surgeon will yield excellent results with longevity of up to ten years depending on how well you age forward and take care of your skin, avoiding further sun damage.

Obesity: People with elevated body mass indices will accumulate increased fat throughout the body. The neck is no exception. Very mild amounts of fat excess with firm, good quality skin may realize improved contours with Kithera (an injectable product that dissolves fat in the neck). However, in my experience, few patients I evaluate are ideal candidates for this treatment. The injection results in inflammation, which can cause collagen production and skin remodeling, but most people need bigger guns to fight the battle. The price of several rounds of injections is as much as a true liposuction with less effective results.

If you have significant fat in the submental region and reasonable skin quality, liposuction can be a great treatment option to uncover a more normal neckline without a lot of expense or downtime. However, a face/neck lift with a corset platysmaplasty is the tried and true corrective option that works very predictably.

If you’re obese and undergo bariatric surgery or make lifestyle changes to produce massive weight loss, you’ll likely develop excess deflated skin that hangs off your face and neck creating an aesthetic deformity. Modifications of standard face and neck lifts must be incorporated to achieve a pleasing result.

The takeaway is that if you’re unhappy with your jaw and neckline, you can improve your appearance and boost your self-confidence by seeking out proper consultation with an experienced plastic surgeon. During the consult, a detailed facial analysis should be performed. Treatment options can be formulated to yield the best results by addressing your unique issues as presented during the interview. No need to hide your neck behind scarves and turtlenecks any longer.

Common Questions patients have about post-bariatric body lift procedures

1. Will a lower body lift fix all my problems that concern me after massive weight loss?
The surgery of the lower body lift is a constellation of several procedures rolled into a single anesthesia event. It amalgamates an abdominoplasty with a lateral thigh lift, a lower flank-plasty, and buttock augmentation with the patient’s tissue derived from the flanks to give a shapelier appearance that is not flat and amorphous. Many people who have experienced the loss of over one hundred pounds have many areas troubling to the patient beyond the mid and lower torso. These individuals have redundant hanging skin of the arms and medial thighs, significant aesthetic deformities of the breast, and often premature aging of the neck and face. These above mentioned areas are addressed with additional procedures performed separately such as a breast lift with or without a brachioplasty (arm lift), medial thigh lifts, and face- neck lifts. Patients also typically inquire about the order of the procedures and I often state I prefer to perform the lower body lift first to establish the “Keystone “ area of the torso and then I can better make aesthetic judgements about the breasts and thighs with respect to the shapelier proportion of the new torso.

2. Will I spend the night in the hospital after the lower body lift?
Although the lower body lift with all its components takes about 7.5 hours of anesthesia time, The Lucas Center of Plastic Surgery’s protocol is for an outpatient surgery status. People seem amazed at this concept. My explanation is a hospital is for sick patients who require monitoring of unstable vital signs, severe pain requiring IV pain management, the inability to take oral consumption of fluids and nutrients, or the requirement of IV antibiotics. After this very significant surgery we have done very thorough evaluation of what is required to make a patient comfortable, safe and recover in an expedited manner. First of all the surgery utilizes a technique supplemented with tumescent anesthesia which provides local anesthesia with a blood vessel constrictor (epinephrine) which results in a very limited amount of blood loss eliminating any risk of unstable vital signs postoperatively. We also ensure adequate pain management with the combination of a long acting local anesthesia pump to control pain along with narcotic analgesia. There are no limitations on what you can or can’t eat afterwards. At home pain medications can be dispensed as needed, as compared to a busy hospital when your pain control may be limited by the availability of the nursing staff. Home limits the risk of hospital acquired infections which can occur on the nursing floors. Lastly one of the biggest safety measures is the prevention of deep venous thrombosis and pulmonary emboli. Early ambulation even the night of surgery is one of the most important factors along with chemo-prophylaxsiswith Lovenox which can be easily administered at home. In the hospital ambulation is once again limited by the nursing staff availability and can result in almost no mobilization the night of surgery or beyond. In conclusion home is the best place to be after this operation.

3. What are the things patients will be responsible for after surgery?
A patient will wake up in a compression garment that helps to limit swelling and support the abdomen. Four drains will be placed during surgery to reduce fluid collections on the abdomen, flanks and lateral thighs. This will require some care to encourage fluid drainage and the patient or the care giver must measure the output to determine when the drains can be removed. All incisions are closed deeply with resorb able sutures with a layer of a glue –like substance over top so no incisional care is required for two weeks. The patient may shower the first post-operative day. The most comfortable position to rest is in a reclined position to reduce the tension on the abdominal closure.

4. When can I resume normal activities and exercise?
This is a very significant operation which can result in a whole new lease on life by liberating the patient of the imprisonment of the excess hanging skin of the torso. However this comes at a cost of being quite sore and requires subsistence living for about two weeks. After this time many of the inflammatory chemical released by the body as a result of surgical trauma have cleared and most people begin to feel significantly better and are able to resume a more normal life. To feel completely normal it takes around six weeks which is also the time frame to return to regular exercise.

5. What are lifestyle loans? Can they be utilized to finance these procedures?
Lifestyle loans are now becoming more popular and several institutions such as Credit Unions and banks in Knoxville, Tennessee offer loans for cosmetic surgery procedures up to $10,000 with rates as low as 9.20% APR for up to forty eight months. This is substantially more attractive than other popular finance plans to help finance larger procedures such as body contouring after bariatric surgery. Please contact your local bank or credit union for more details.

The bottom line on fat grafting

The buttock area has reached new levels of interest thanks to the influx of the Latin culture from South America and pop culture’s fixation on the shapely, self-absorbed Kardashians. Surgeons on the cutting edge of buttock enhancement choose to use fat grafting instead of buttock implants to avoid some very difficult complications.

Thanks in part due to Dr. Simeon Wall’s concept of tissue equilibration in body sculpting, tissue can be removed from areas of excess and transposed to areas of deficiency. For example, we can take excess areas like the muffin top and the lateral thigh and place that fat into the under-projected gluteal areas creating the idealized shape of the buttock both in terms of the outer framing and the projection.

The breast is another area where fat is very important. Most of the breast volume under the skin is composed of fat with small islands of glandular material dispersed throughout. With aging, volume in the breast is lost by glandular atrophy and some fat loss. Previously breast rejuvenation or enhancement was only thought of with augmentation via implants, with or without tissue repositioning such as a mastopexy. Today fat grafting is critical to achieving superior results. Research suggests that over 60% of breast augmentation procedures could be improved with the addition of fat grafting performed simultaneously.

Furthermore, fat that is harvested contains peripheral stem cells. The presence of stem cells in harvested fat has implications for rejuvenation medicine and the potential growth of tissue such as bone, skin, solid organs and bone marrow cells. Unfortunately, the art of marketing has outpaced science, and many clinicians are calling fat grafting to the face a “stem cell face lift.” This is a misleading statement. Much energy has been directed toward the understanding of the stem cell, but it’s not ready for prime time yet.

Plastic surgeons employ biologic tissue as our medium to create beautiful forms of living art. Fat is a wonderful way to sculpt the human body. It is truly like airbrushing imperfections in three dimensions.

Regardless of the Kardashians over-developed assets, fat grafting is worth the hype. Call 865.218.6210 today or go online to thelucascenter.com to schedule your consultation. I look forward to discussing with you the myriad of options for face, breast and buttock enhancement via fat grafting.

Liberate your body and spirit with a total body lift after weight loss

Body contouring
As a plastic surgeon, I see patients who have lost amazing amounts of weight through bariatric surgery and have used this to champion new lifestyles which can eliminate diabetes, hypertension and sleep apnea. Often these patients can discontinue all medications previously taken under a physician’s care. Unfortunately, post-bariatric surgery patients, who are otherwise healthy and active, find themselves prisoners in their own fortresses of hanging flesh.

People feel better, but they don’t look better because of the excess skin on their faces, arms, breasts, abdomens, flanks, buttocks and thighs. Many bariatric surgeons try to provide surgical rejuvenation procedures themselves, leading to less than desirable outcomes and even unnecessary deaths. Plastic surgeons have additional training and expertise and are uniquely qualified to provide patients with a “get- out-of-jail card” from their excess skin. The important principles of body contouring procedures can only be learned in a plastic and reconstructive surgical residency.

What are the procedures that can help you look and feel better?

A total body lift is usually broken up into three distinct procedures, each one taking 6.5 to 7 hours to perform. These are complex and nuanced procedures that necessitate a tremendous amount of skill to remove and reshape the skin. This operation is a life-changing event, and everyone is universally very happy.

1. Circumferential lower body lift with gluteal augmentation: The first procedure I routinely begin with is the circumferential lower body lift with gluteal augmentation with vascularized flaps from the flank region. Upon completion of this surgery, I can make better aesthetic judgments about the breasts and legs. The lower body lift is actually three separate operations performed at the same time: a tummy tuck and flank-plasty with lateral-thigh repositioning and gluteal augmentation utilizing skin from the muffin top and positioning the tissue into the gluteal region to enhance the buttocks.

Despite the long surgical time and the complex number of procedures performed, I almost always send patients home that night. They actually do much better at home than staying in the hospital. All incisions are closed deeply, so no sutures need to be removed. There are four drains, which stay around a week. We utilize a pain pump with a long acting local anesthetic to block pain response. Everyone gets a blood thinner for five days to prevent clots. It generally takes around two weeks to start feeling better.

2. Upper body lift (bilateral brachioplasty with lateral chest wall reshaping and breast rejuvenation): The next procedure is usually a combined upper arm and lateral chest wall contouring (otherwise known as an extended brachioplasty). This surgery is often blended with a breast lift with or without an implant. The brachioplasty is a one-stage procedure with very few complications, and patients love the results. The breast rejuvenation is almost always a two-stage procedure, because the tissues after weight loss are quite complex. If the residual breast tissue is very thin, it may require an implant to help create shape and volume during the second stage.

3. Medial thigh lift: The final surgery is typically the lateral thigh lift. In most cases, we perform aggressive liposuction in the area of the medial thigh, then resect the loose tissue left after the liposuction. The incision spans from the knee to the groin crease on the inner aspect of the leg. This allows us to transversely tighten the skin in this distribution for a much smoother, firmer look. Patients can resume fairly normal activities in a week. It’s a transformative experience to feel comfortable in shorts, dresses and pants by unburdening yourself of loose, hanging skin.

If you have lost significant weight from bariatric surgery or by other means and are experiencing the difficulties of carrying around excess skin that is adversely affecting your quality of life, please contact me at 865.218.6210 or go online to thelucascenter.com to begin your three dimensional rejuvenation today.

Plan your abdominal rejuvenation before swimsuit season starts

After a very difficult wintery month of February, we’ve finally arrived in March with the anticipation of spring and nice weather to follow. During this time in East Tennessee, people are thinking of getting their boats and pools ready for enjoyment. Are you dreading the idea of putting on your bathing suit or, even worse, shopping for a new one, because you hate the way your stomach looks? Boost your self-confidence by calling The Lucas Center Plastic Surgery for a private consultation to improve or rejuvenate your abdomen.

Giving birth to children, weight loss or weight gain, or even previous surgeries on the belly can be a significant detriment to your appearance. Don’t fret. Take control of the situation. Come see me for a thorough evaluation of your problem areas. I’ll provide you with a detailed plan to address your particular situation.

If your problem is loose skin with poor elasticity then a tummy tuck (abdominoplasty) may just be the right approach. The goal of this surgery is to remove the loose skin, tighten the abdominal wall to provide a tighter, sleeker appearance and remove excess fat at the same time. The initial recovery takes around two weeks, but you’ll need four to six weeks to be at your best again.

I’ve handpicked a dream team of warm, caring staff that will welcome you and walk you through the consultation without causing you to feel judged or intimidated. We understand how frightening it can be to come to a place and discuss what makes you feel uncomfortable and even get undressed and show a complete stranger your most-hated body parts. Trust us, nobody is perfect. Our goal is to ease your mind and provide you with a plan that will improve your look and your self-esteem in a proven fashion that is safe and effective.

So what are you waiting for? Call 865.218.6210 today or contact us online to get ready for summer!

A Lift That Gives You a Lift

At The Lucas Center, we think of cosmetic surgery as more than just a procedure. It’s a lift that gives you a lift! Boosting your confidence is our goal, from the first phone call to your outpatient care. Dr. Lucas is known for his precision and will prioritize your wants and needs each step of the journey.

satsifaction2jpg 

Get your confidence back! If you feel good, you are going to shine in every aspect of your life. Plastic surgery will give you a lift in multiple ways. A study revealed that 87% of patients were satisfied with their surgical improvements, including an overall boost in confidence and positive experience with the specific procedure. To learn more about how Dr. Lucas can help you feel and look your best, watch this abdominalplasty testimonial:

[Source:  http://www.surgery.org/consumers/plastic-surgery-news-briefs/plastic-surgery–lift-give-lift-infographic-1051301

Body Lift Testimonial

It is our goal to help you become your best self yet. We love nothing more than to hear customers come back and say how their lives have changed for the better since working with us.

Peggy is a body lift customer who lost more than 150 pounds and came to us to tighten up all the loose skin. She is a fabulously confident and happy woman now that she feels comfortable in her own skin. We couldn’t be more thrilled to have been a part of her journey.

Watch her testimonial:

If you have any questions about a body lift, or any procedure, please give us a call today at 865-218-6210. We want to be a party of your journey!