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Shafer Plastic Surgery Frequently Asked Questions From Real Patients.

 
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Breast Augmentation

1. QUESTION: How much weight should you lose after breast augmentation before it affects the appearance?

ANSWER: There is not a magic number that applies to everyone.  Within a normal range of weight variances, say 10 pounds or so, there should really be no differences.  With major weight loss, there may be some changes, but these depend on the ratio of fat/breast/implant volumes as others have stated.

2. QUESTION: Breast Augmentation Seroma Treatment with a Pill?

I had cosmetic surgery a couple of weeks ago, and I have some blood/fluid build up (a seroma I think?) Is there a medication or pill my doctor can subscribe for me that will eliminate the seroma?

ANSWER: Unfortunately, there is no magic pill for seromas. You may end up needing a couple of drainages. If it is persistent, they may be able to leave the drain in it, so you don't need to be continually poked. If that does not work, you may need to have it sclerosed or, in rare cases, have another surgery. However, after just one drainage, don't get too worried. Good luck with your recovery.

3. QUESTION: Breast settling after Breast Augmentation.

I had breast augmentation done 4 months ago. In addition to my right breast now sitting approximately a half inch higher than my left breast, and both have a significant amount of loose skin under the breast.

My Doctor has me wrapping my breasts in a bandage for 6 weeks to try to work them down into the breast pocket. Is this going to give me the desired effect, or will I eventually need to have them redone?

ANSWER: I have found that it usually takes about six months for the breast implants to properly settle. However, what you describe presents two issues. First, if one implant is higher than the other, you may require a revision surgery to fix that asymmetry. While wearing straps may help, at this point, I would not expect much difference. Second, the "loose" skin under the breasts, may indicate that you also need a mastopexy or breast lift. While the implants may settle somewhat, if there is breast tissue hanging off of the implants, this is unlikely to resolve without further surgery.

4. QUESTION: One week post op Breast Augmentation complications.

On 5/11/11 I had breast augmentation, under the muscle thru the armpit. The day after surgery I noticed the right breast was significantly more swollen/higher than the left and deep purple bruising appeared down the entire right side of my torso to my hip area. Three days after surgery a "new" bruise with slight lump appeared under the right breast and bruising has spread under the breast. Have seen my PS and he put me on muscle relaxers and icing every hour with follow up on 5/23/11. Normal?

ANSWER: As others have mentioned, increases swelling, bruising and tightness immediately after breast implant surgery may indicate a hematoma or blood collection around the implant.  If this is the case, it most likely needs to be drained surgically and medications will not make it go away.  It is important to follow closely with your surgeon as they know what was done during surgery and what to expect.  If there is uncertainty, imaging studies such as ultrasound can be done to look for a fluid collection.  However, in most cases, hematoma is obvious and needs to be treated.

5. QUESTION: Vertical lines under crease and pulling after Breast Augmentation?

I had a BA almost three weeks ago, and am noticing vertical lines under the crease, particularly when I raise my hands. They are painful, but not excruciating, but do cause some discomfort when I am wearing a bra. I feel a pulling sensation as well where the lines are located. What is the best treatment for this condition, and how long should I continue that treatment? The incision area is also really bumpy when I push down on it, however the skin feels smooth....is this normal?

ANSWER: Thanks for posting pictures, it is very helpful in answering your question.  These lines are from tension from the deep sutures closing the incision.  When you raise your arms, it increases the tension and makes the "string look" under your skin.  These are dissolvable sutures and will disappear as the suture dissolves - likely 4 to 8 weeks.

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Breast Lift

1. QUESTION: Scarless Breat Lift.

I'm sort of on the verge of needing a breast lift and wondering if the scars are not worth the trade-off... what kind of incisions or techniques leave the least amount of scarring?

ANSWER: Marian, Many patient are afraid of the scars / incisions used to perform breast liftsurgery. However, in general, these incisions heal very nicely. It is a shame when patients compromise their result by demanding shorter or fewer incisions. There are minimal incision breast lifts, but these are best for people who only need a minimal lift. For people who need more extensive lifting, then you need longer or different incisions to achieve a nice aesthetic result. Sometimes, if you have an implant placed at the same time as the lift, then you may not need as long of incisions, but this also depends on your anatomy. I hope this is helpful.

2. QUESTION: What type of lift would I need?

I am considering of having a lifting procedure combined with implants, I am very concerned about the scars, but according with the shape of my breast, what kind of liftind do you think I need?? any suggestion will be really appreciated Thanks

ANSWER: Thanks for posting pictures.  It makes the questions and answers much for informative for everyone.  Based on your pictures, I would suggest a full mastopexy - lollipop and anchor incision.  Additionally, the placement of a small implant at the same time will help with upper pole fullness in your breast.  You can talk with your surgeon about different sizes and profiles to meet your needs and your anatomy.

3. QUESTION: Can an uplift be done without the anchor scar?

II have implants already but still have a small amount of excess skin that I am not happy about. I do not want bigger implants than I already have. I'm am 26 and do not really want the anchor scar from an uplift cut around the nipple. Can an uplift be done in any other way?

ANSWER: The incisions used really depend on the anatomy of the patient.  If there is minimal skin, then you may only need the vertical incision.  However, without seeing pictures or evaluating you in person, it is impossible to give you specific advice.

4. QUESTION: Will a Breast Lift make my breast look smaller, or larger?

i there, Almost two years ago after 3 back to back pregnancies i had my 275cc saline implants replaced with 375cc HP silicone. At the time I was afraid of the anchor scar so I did a donut lift instead. I'm now considering going back for the lift but I'm concerned my breasts will end up looking smaller. Im a 34DD in VS brand bras...Will I need a larger implant with the lift to keep my large size? Thank you:)

ANSWER: With breast lifts, some skin is removed and the contour of the breast reshaped to achieve the lift.  While the volume of the breast (minus the small weight of the skin removed) will be essentially the same, the breast may appear slightly smaller.  If you are looking to maintain the exact same size, then you may want to consider getter one size larger on your implants at the same time as your lift.

5. QUESTION: African American worried about Benelli Lift scar, what can I expect?

In my reading the Q/A in realself, I came across a PS that said African americans should NEVER use an areola incision beacuse of scarring. this has really bothered me because i was finally happy that I didnt have to have the lollipop scar and I thought this scar would be much less noticable. I also have very large areolas and my PS is making them smaller. Please let me know if I will absolutely have terrible scarring or does it vary from cast to case. Also, 400cc too big for Benelli lift?

ANSWER: Without pictures or seeing you in person, it is impossible to give you specific advice.  However, most people who are looking for a Benelli lift really should consider a traditional life.  The Benelli lift places a lot of tension not he incision which can make the scar wide.  Additionally, without the vertical component to the lift, there is less control over the shape of the breast.  So, those patients that demand a smaller incision are really doing themselves a disservice by limiting the full potential of what can be achieve with surgery and often end up with a  smaller but less aesthetically pleasing incision.

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Breast Reconstruction

1. QUESTION: Possible to have over the muscle Breast Augmentation after Masectomy?

I am post bilateral mastectomy, after 10 years, I finally have expanders. They were placed in Nov. I am having pain 6/10 on one breast area and to the shoulder and arm.. I am afraid that after the implants I will continue having pain. Can the Breast implants be put over the muscle? Or is there an artificial muscle that can be used?

My concern is how to distinguish breast pain vs cardiac pain in the future. Implant schedule is in April.

ANSWER: In most cases, it is best to have the implants below the muscle after mastectomy. During the mastectomy, all of the breast tissue was removed, which leaves only skin. It is not safe to only have a very think skin layer between the outside environment and the implant. If your expanders are in place under your muscle and you are still undergoing expansion prior to the final implants, you may have some discomfort during the expansion process. It is best to discuss this situation with your breast andplastic surgeons. If there is a lack of muscle then sometime a dermal substitute can be used to bridge the gap. Also, if you have muscle spasm, you may want to discuss Botox injection into the muscles to help them relax. Good luck with your recovery.

2. QUESTION: Do Breast Reconstruction tissue expanders cause pain as they expand?

IIt seems like a tissue expander would be painful as it stretches the skin - am I crazy?

ANSWER: Marcia, You are not crazy. Aggressive expansion can be painful. However, if you do not rush the process and use appropriate medications, such as pain medications and valium, gentle expansion of the muscle/skin envelope does not have to be painful.

Additionally, if your surgeon uses Alloderm or some other dermal substitute during your expander placement, it may be possible to expand more during the initial operation, leaving less expansion to do in the office. Good luck with your surgery.

3. QUESTION: Skin-sparing Masectomy.

I just read an article that said a lot of board-certified surgeons in CA reported they are still using traditional techniques for mastectomy, cutting across the whole breast and leaving unnecessary scars. Why would surgeons do that instead of using skin-sparing mastectomy technique? Is there any reason that would justify not performing a skin-sparing mastectomy in favor of a traditional (and disfiguring) mastectomy?

ANSWER: Skin sparing mastectomies are a great advancement for breast cancer surgery. An extension of these is the nipple/areolar sparing mastectomy which give great results in the right patients. However, all breast cancers are not the same. Skin sparing mastectomy is best for small cancers that are not close to the skin. However, more severe cancers that are large or close to the skin, may require traditional modified mastectomy incisions. It is unclear from the report that you site whether the surgeons they surveyed perform traditional mastectomy some of the time or all of the time. I think that this clarification is important, since if you need a traditional mastectomy and the surgeon does not perform them, then you are not better off. It is important that you research all of your options before undergoing any surgery. Also, I would hope that most surgeons have your best interest at heart. It would be devastating if your cancer returned because an inadequate tissue (skin) resection was performed.

I hope this helps.

4. QUESTION: Remove my breasts and nipples to look like a male?

How Similar is the Breast Reduction Operation to a Mastectomy? I would like to remove my breasts and nipples. I'm looking for a surgeon who will make my chest look like a male's sans nipples and with minimal scarring. Will a skilled breast reduction surgeon be a good choice for my mastectomy or are these two completely different surgeries? Does my not wanting my nipples make the surgery less complicated?

ANSWER: Any plastic surgeon is trained in breast reduction surgery - this is a common procedure. What you are asking for is unusual, but the procedure would follow the same basic concepts as breast reduction surgery. Your resultant scars would really depend on the size of your breasts. There is no way to perform the surgery without making incisions or without resultant scars. If you have small breasts, you may be able to have liposuction which would decrease the size of your breasts, but not address the nipple or areola. You could have the nipple and areola excised, but there would still need to be an incision and a scar. Good luck.

5. QUESTION: Breast Reconstruction options.

What are the benefits of having breast reconstruction at the same time as mastectomy, and in which situations would it be recommended to postpone reconstruction?

ANSWER: Teresa, There is not one answer for this question. It really depends on your specific situation and would be best be answered by your breast surgeon. Factors which effect the answer include your stage of cancer, need for radiation or other treatment, skin envelope, etc. Good luck with your surgery.

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Botox

1. QUESTION: How much does Botox cost?

II am going to get a Botox injection for frown lines, forehead lines, and crow's feet.  Can a doctor please tell me - What is the best price for Botox or average cost?

ANSWER: Offices charge for Botox in two ways - either by "area" or by "unit."

It is my feeling that charging by "area" leads to fraud since the office can dilute the Botox by whatever ratio they want and the patient never actually knows how much Botox they have received.

There is also the possibility of cross-contamination between patients since the office is using the vial over and over again for several patients. The alternative way of charging for Botox is by the "unit."

Allergan just started supplying 50 Unit vials of Botox. In my practice, this is the average amount of Botox for a typical patient. 50 Units will cover the crow's feet (2.5 units each), the glabella (25 units) and the forehead (20 units). This amount of Botox allows for significant reduction in wrinkles but allows you to maintain facial animation.

The charge per unit varies around the country from anywhere between $9 and $20+ per unit. In my practice, I charge a flat fee in 50 unit increments.

The second vial is only needed if you are having your neck treated for bands or your scalp treated for headaches.

It is my policy to open up the new vial of Botox right in front of the patient so they can be assured that they are getting fresh product and getting what they are paying for.

2. QUESTION: How many Botox units for 11's or frown lines?

I received 20 units of Botox yesterday. Now I think I may have been cheated, he just wanted to get his $256 and the 20 units he injected were not nearly enough to get "rid" of the moderate/severe "11's" on my forehead. What is the average amount of units needed for this?

ANSWER: I can understand your frustration. However, you state that you just had the Botox yesterday. It will take 3 to 7 stays for it to start working and sometimes up to 2 weeks for the final effect. So, please be patient to see the effect.

However, it does usually take between 20 to 30 units for the glabella (your "11's") area. It takes another 15 to 25 units for your forehead and another 2.5 to 5 units for around each eye (crow's feet).

I hope this is helpful.

3. QUESTION: Which eyedrops are best for droopy eyelid due to Botox?

ANSWER: Drooping eyelids after Botox is a very rare but real side effect.  If you eyelids appear "full" due to your brows drooping then there really is not a good treatment except time for the Botox to ware off.  If your eyelids are drooping on their own but your brows are in good position, then drops such as Iopidine can be very effective.  However, you may need to take the drops several times per day for several weeks until the Botox wares off.  Good luck.

4. QUESTION: When will the swelling, puffy eyelids go away?

Eight days after my Botox injections my eyes became extremely swollen. I applied a cold compress and the swelling went down considerably, but my eyelids are still puffy and its 11 days since my injections. Is this going to go away?

ANSWER: Sometimes after Botox people complain of "swollen eyelids." This is most likely not swelling. It is because the Botox was injected too close to the eyebrow. It is no surprise that this happened 8 days after your injection, since this is when the Botox had finally started working (it takes 3 to 7 days for the Botox to take effect). The eyebrow then drops (ptosis) and the skin between the upper eyelid and the eyebrow gets compressed into a smaller space - the distance between the eyebrow and the upper lid become shorter.

This makes the upper lid skin puff out since it has nowhere else to go. So, I would recommend looking at your pre-injection photographs and compare the level of your eyebrows. There is no solution for this except for time - 3 to 6 months for the Botox to go away. This most often happens to patients only the first time they have Botox.

It is very difficult to predict which patients will have this response. If you do have this response, then you will know the next time you have Botox to have it injected higher above your eyebrows. This is a compromise, since you may be left with a wrinkle above your brow, but that is better than the dropped brows.

5. QUESTION: Severe hematoma from Botox.

I decided to have my first Botox procedure done after diligent research, and I chose a Board-certified plastic surgeon to administer the Botox injection for my under eye creping. The doctor said he hit an artery/nerve, which most likely caused immediate swelling and hematoma on the area. I did everything I can--ice, elevation, topical and oral arnica, applied heat, massaged it lightly, and put vitamin gels--but 8 weeks later, the bruising and swelling are still there. Will this ever go away, and what should I do now?

ANSWER: I am sorry to see that you had such an experience with Botox. Certainly this is a very rare complication - I personally I have not seen this happen with Botox injections. However, regardless of what is being injected, if a superficial artery or vein is punctured, this is a possible outcome. 8 weeks later is a long time for the bruising to still be present. It sounds like you are doing everything right.

Talk with your doctor about possible referral for further interventions such as ultrasound or laser to help hasten the recovery process. If there is a palpable pocket of fluid, then your surgeon may be able to drain it his or herself for you. I hope this is helpful.

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Dermal Fillers

1. QUESTION: Are fillers safe? I found this on a prominent surgeons website.

Prominent surgeon states that a new set of problems has appeared for many of his patients with..He states many of these patients have devastating problems. Patients are presenting with such complications as chronic infection, pain, persistent redness and swelling, and even permanent skin damage. Many of these patients are not able to undergo corrective surgery because their skin is damaged so severely that surgical correction would risk severe deformity or skin necrosis/loss.

ANSWER: Dermal fillers, when injected by qualified and experienced injectors are safe and effective.  The line you quoted when typed into google seems to match a website of a facial plastic surgeon discussing fillers of the nose.  Injecting fillers in the nose is an off-label application.  Additionally, injecting fillers in the nose requires exceptional care and skill to avoid the complications which he discusses.  However, when injected in the right patients, the fillers are very safe and effective.  When using an HA filler, they are even reversible.  If you are considering filler treatment of your nose or anywhere else, I would suggest that you arrange a consultation with a board certified plastic surgeon to discuss your options.

2. QUESTION: Exercise risky after filler injection?

Is there  any risk of being highly active (as in running) after fillers are injected?  I am a runner and fear that if I use a filler it will sag and "drop" beneath the skin due to running or other physical activity.

ANSWER: Sally, It is fine to exercise and run after having dermal fillers. After the filler is injected, it will not move within your skin. My only precaution would be to avoid exercise the day of treatment to avoid raising your blood pressure - the only harm would be possibly potentiating the temporary swelling and bruising that you may experience after your injections. Good luck with your fillers.

3. QUESTION: Best fillers for large hollowed areas?

I'm a 37-year-old female. While my facial skin still looks quite fresh, my cheek bone and jawline areas are so hollowed they make me look tired and old. I've considered Sculptra and other dermal fillers, but I'd like to know if there's anything long-term or permanent for restoring these large hollowed areas.

ANSWER: Not all fillers are appropriate for all people or all locations on the face. Around the lips and nasolabial crease, the HA products such as Restylane, Juvederm and Prevelle work well. Evolence, a collagen-based product is also good in these areas.

For the cheeks, Radiesse or Sculptra are nice fillers as they provide more substance and structure after injected. Be very careful with permanent or long-term fillers since you can not easily remove them if you do not like the results.

One of my favorite fillers is your own fat (from your abdomen or thigh). I remove the fat with a mini liposuction technique and then isolate the fat cells using centrifugation. The fat cells are then transfered into syringes in preparation for injection. One of the nice things about using fat is that most people have an unlimited supply. Therefore, much larger areas can be corrected without having to spend the money on multiple syringes of artificial injections. Another benefit of fat injections is that it is natural - it is your own fat. If your body incorporates the fat, you have the potential of significant long-term effects.

I hope this is helpful.

4. QUESTION: Safe to get Restylane and Botox while on antibiotics?

I'm having my first procedure tomorrow. I'm planning to have Restylane on my nasolabial folds and Botox on my forehead. Is it safe to have these done on the same day, and while I'm on penicillin (because I have tonsilitis)?

ANSWER: It is perfectly fine for you to have both Botox and an injectable on the same day. Most people choose to do it this way, since there will only be one recovery period. Also, since most of the injectables last around 6 to 9 months and the Botox last 3 to 6 months, people come in for Botox every 4 months and do the injectables every other visit. Being on antibiotics should make no difference at all.

5. QUESTION: I have Crohns: Can I get Radiesse or any filler?

I want more chin. So I decided to Get filler. My PS said Radiesse and Restylane. I have an app this month. After seeing that MOST reviews On Radiesse are horrible. (bruising for 1.5 years, imune problems, lumps, migration to other parts of face, and i guess because Radiesse stays in the body etc ) Im scared to try it now. How is it that most chin implant surgery reviews are great and most Radiesse reviews are a nightmare, damaging lives? Is this alright?

ANSWER: First of all, having Crohn's disease does not preclude you from having any dermal filler treatment.  Second of all, Radiesse is a great product when injected properly.  It is true that once Radiesse is injected, it can't be removed. So if you are nervous about the results, then you may want to try an HA filler first such as Juvederm or Restylane which, if you do not like it, can be melted away with an injection of Vitrase.  

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Facelift

1. QUESTION: Natural Facelift options - Do they work?

I was researching natural facelift options and keep seeing forums where women talk about fantastic products that do indeed lift and firm your face, diminish lines especially crows feet and frown lines. i have not found any thing that does this natural face lifting.  is it my skin or degree of skin saging, or do you think these people are shills in blogs and forums?

ANSWER: If you need a facelift, there is no alternative. If you just have fine lines around your eyes, you may benefit from Botox Cosmetic for the crow's feet. If you have moderate nasolabial folds, you may benefit from fillers. However, if you have any loose or drooping skin, then facelift is really your only alternative. Good luck.

2. QUESTION: Facelift surgery scars.

Will I have visible scars from a facelift?

ANSWER: It is impossible to say with 100% certainty that your incisions will heal perfectly. Incision healing is dependent on several factors, including surgical technique, prevention of infection, reduction of tension, patient nutrition, not smoking (before or after surgery), genetics, etc.

For the most part, however, facelift incisions heal very well. The incision starts in front of and within your ear and then curves behind the earlobe and extends along the crease behind your ear. For the first several weeks after surgery, you will definitely be able to see the incisions, so it is best if you have longer hair that can cover them. However, you can also be creative, such as wearing glasses with a hanging lanyard that hangs in front of the incision.

Alternatively, you can just go along your business like noting happened. If you live in a metropolitan area where many people have plastic surgery, then it really will be no big deal. Those people who notice it probably have had the surgery themselves (they know what to look for). However, after several weeks to months, the incisions fade away and just become a memory. I hope this is helpful.

3. QUESTION: How many stitches does a Facelift require?

How many stitches are there in an average facelift? What's considered a normal amount?

ANSWER: If someone is trying to sell you a facelift based on the number of stitches, I would recommend going to someone else. The number of stitches used during a facelift is individualized for each patient and judging a facelift by the number of stitches is irrelevant. Facelift surgery is very complex. It is more how you put the stitches and where you put the stitches than how many you use.

4. QUESTION: Face lifting and fillers to pump up my face?

Can I have a face lifting to fix the wrinkles and have fillers to pump up my face? Can I do them simultaneously?

ANSWER: Without seeing pictures or seeing you in person, it is impossible to give you specific recommendations.  However, a combination of face lift and fillers is possible.  Another alternative would be facelift and fat grafting, which I do in almost every case.

5. QUESTION: Midface lift or other procedures for sagging face (age 24)?

Hello. I am reposting my question with more pictures. I am 24 and my face looks old and sagged, applecheeks are almost lost, nasolabial folds quite prominent, lower eyelids unnaturally droopy, there seems to be too much skin yet hollows in the middle of my cheeks (also under my eyes when I laugh). I want to have a younger looking face and tighter cheeks, but do not know what to do. Thanks for your time.

ANSWER: At 24 years of age, you really are too young to consider facelifting procedures.  Based on your pictures, you look like you would benefit from some jawline liposuction and midface fillers.  These procedures are minimally invasive, less expensive and can make some nice improvements.  

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Liposuction

1. QUESTION: How long after liposuction is pain and swelling normal?

I had Liposuction done on my upper/lower ab and love handles. I am 5 days post-procedure and I still have a good bit of discomfort and swelling. Is this normal, and how long does it usually take before the swelling goes away?

ANSWER: Lucy, You are just five days post-procedure, so I am not surprised that you still have swelling and discomfort. Rest assured, however, you will improve quickly. It takes about two weeks for a majority of the bruising and swelling to resolve. However, it takes another two to four months for all of the swelling to completely resolve. You will continue to see positive improvements during this time. I can tell you from first-hand knowledge (I had liposuction myself) that whatever you are going through right now if completely worth it. Just give it some time and your symptoms will improve. Enjoy your new body!

2. QUESTION: Liposuction recovery using compression garments or spanx?

Can I use Spanx instead regular compression garments during my recovery from liposuction?

ANSWER: Both compression garments and Spanx are good for post-liposuction compression. It goal is to have compression over the areas which were treated. So, it really depends on which garment or Spanx garment does the job. The Spanx tend to be a bit less expensive and more comfortable. However, you should discuss it with your surgeon.

3. QUESTION: Who is qualified to perform liposuction?

Can any doctor do liposuction, or would I need to see a specialist of some kind?

ANSWER: While many people do liposuction, many of those people should not be doing liposuction. Plastic surgeons are specifically trained to do liposuction as part of their surgical education. Many other specialities (just look through the ads in a newspaper on any given day) advertise that they do liposuction as well. However, it is unclear to me where they get their training. My best advice would be to go to a few consultations to plastic surgeons who have performed liposuction on people you know that have had nice results. If you do not know anyone who has had liposuction, ask the surgeon if any of their patients would be wiling to talk to you about their procedure. Questions to ask the doctor include: What type of liposuction they do? What type of anesthesia is used? How many liposuction procedures they perform in a given month? How often do they have to make revisions? How much do they plan to aspirate? If they are doing the liposuction in their office or a surgicenter, ask them at which hospital do they have admitting privileges?

You should find a surgeon who you feel comfortable with and who takes the time to answer all of your questions and addresses your concerns.

4. QUESTION: Compression garment concerns after Liposuction.

I'm 26yrs old, 113 lbs and had 550 cc's removed from my stomach/flanks through Liposuction exactly 1 week ago. The compression garment the doctor gave me is adding to the lumpiness (I knew to expect some). Is the type/brand of garment important for outcome? Is tighter/stiffer better? My ribs are little sore. Is this amount of unevenness normal? Thank you!

ANSWER: 1 week after lipo is early to get worried about anything. You still have considerable swelling to resolve. In the long run, the garment does not really matter. The garment helps with short-term swelling reduction and helps reduce pain due to shearing forces. You are not wearing a garment anyway, you are wearing a binder. You might want to consider something like a Spanx garment, which is form fitting and seamless. You will get less short-term ridging like you have from the binder. All this goes away anyway with time since it is due to short-term differential swelling. Any lumpiness is due either to your anatomy or the liposuction technique. In any case, it takes several months to see the long term results. Good luck.

5. QUESTION: Liposuction surgeon consultation.

What should I ask my doctor during a liposuction consultation?

ANSWER: This is a great question. Many doctors out there advertise liposuction. Additionally, many companies have come up with fancy names for different types of liposuction.

  • The first thing to ask your doctor is about his or her training. Plastic surgeons have specific core training in liposuction techniques. Additionally, some plastic surgeons go on for extra fellowship training specifically in aesthetic plastic surgery which includes liposuction. Many other doctors in different specialities take weekend courses in liposuction and then offer it in their practices. So, please ask your doctor specifically about their training.
  • The next thing to ask is about the type of liposuction they perform. Different types of liposuction are good for different types of people. For instance, if you have just minor areas that require small volumes of suction, then a procedure such as Smart Lipo may be best for you. However, if you are like most people and require a moderate to large volume of liposuction, then traditional tumescent liposuction is best. New advances in traditional liposuction such as power-assisted liposuction, make this procedure even more effective. If you have redundant skin and tissue, then you may need a combination procedure such as liposuction and mini-abdominoplasty or tummy tuck.
  • The next thing to ask your doctor is to see pictures of their actual patients or to talk to some of their previous patients. Many doctors have become very savvy at marketing or have great marketing companies working for them. If you look at their websites, they use stock photos which are not their real patients. Have them pull up their website during your consultation and ask them which patients are actually theirs.
  • Next, ask your doctor where the liposuction will be performed. Many doctors perform liposuction in their offices while the patient is awake and other doctors perform liposuction in an operating room while the patient is under anesthesia. If you are having minor liposuction, then the office based procedure may be appropriate. However, ask your doctor about the certifications for their office-based procedures and what contingency plans they have in case something goes wrong.
  • Also, ask them if they use an anesthesiologist or if they do the anesthesia themselves. Next, ask your doctor about follow-up care. Make sure that your surgeon will be the one seeing you in follow-up.
  • Inquire about post-operative garments, medications, exercises, and ability to return to work.

Liposuction is a great operation and, when performed properly, has great results. It can be intimidating trying to filter through all of the information out there about liposuction. In the end, make sure all of your questions are answered and that you feel comfortable with your surgeon before you have surgery. I hope this is helpful.

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Tumm Tuck

1. QUESTION: Can I get a tattoo over a Tummy Tuck scar?

ANSWER: It is perfectly fine for you to get a tattoo over your incision. Many of my patients have done this and I think it looks nice. However, you may be surprised, but the scar/incision will likely not look at bad as you may be expecting. In most cases, after six months to a year, the scar is hardly noticeable. However, this is not true for everyone, so it is nice to have the option to place a tatoo. If you do choose to get a tattoo, I would suggest waiting at least 3 to 4 months before having it done.

2. QUESTION: Healing Bruises After Tummy Tuck & Liposuction

I just had Liposuction and a full Tummy Tuck done a week ago. I'm very pleased with what I've seen so far. However, I have extensive bruising from my hips to my knees, both sides of my stomach area, and the pubic area. How long before these bruises heal, and how can I speed up the healing process?

ANSWER: First of all, you have a great result! Your bruising and swelling look normal for one week after surgery. You will be surprised, but the swelling and bruising will resolve over the next week or so. I usually have my patients go for medical massage starting 10 days after surgery to help with the swelling and lymphatic flow. However, you should discuss this with your surgeon before starting any therapies. Also, avoiding alcohol, salt and spicy foods helps keep the swelling down. Finally, Arnica Montana tablets or cream may help with the bruising. This is available in most health food stores.

3. QUESTION: When can I attempt to suck my abs in or do sit-ups after a Tummy Tuck?

ANSWER: While I encourage walking almost immediately after tummy tuck, I caution to refrain from abdominal exercise for up to 6 weeks after surgery while the sutures are healing.  However, you should talk to your doctor to see what their recommendation is for your individual case.

4. QUESTION: Tightness and diffculty standing up post Tummy Tuck.

ANSWER: SheriBrock, Usually after abdominoplasty it takes about 1 to 2 weeks before you can stand up straight. So, you soon should be getting better. I have found that some patients are afraid to stand up straight, so they really have to push themselves to do it. At this point, you are not going to hurt yourself by standing up. Make sure you follow-up closely with your surgeon to make sure there are not any other issues. Good luck. 

5. QUESTION: Pubic area appears bigger after Tummy Tuck.

'm now 6 weeks post-Tummy Tuck, and I am pleased with the results. However, I'm bothered that my pubic area appears to be 2-3 centimeters higher/bigger that it was pre-operation. My underwear used to cover the area completely, but now they don't. Is this normal? Will the skin eventually stretch back to its place?

ANSWER: During abdominoplasty, the excess skin is removed between the mons pubis and the belly button. However, when the mons is stretched upward it sometimes reaches higher than the bikini line. Therefore, it is very important that the top of the mons also be removed with the abdominoplasty, to keep the look natural. These are important issues to discuss with your surgeon prior to surgery. It is also important to look at post-operative photos of your surgeon's patients to see how they make the incision. Since you have already had surgery, you have to address your result. After abdominoplasty, the mons areas does swell and it can take several weeks to months to completely resolve. If after six months or so, you are still not happy with the level of the mons pubis, you can have laser hair removal. Otherwise, you may need a secondary surgery to remove more skin. At this point, you are only six weeks, so give it some more time. When the swelling resolves and the tissues settle, you may be much happier with the result.

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Dr. David Shafer is a Double Board Certified Plastic Surgeon, a Diplomate of the American Board of Plastic Surgery and a Member of the American Society of Plastic Surgeons

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