Tuesday, September 1, 2009

Circumferential tummy tuck (Body Lift)

What is a Body Lift or Circumferential tummy tuck?

This procedure can be thought of as a full tummu tuck and a buttock lift. The incision goes all the way around the waist, hence the term circumferential, and helps remove skin laxity from the tummy, the hips, and the buttocks. The result is usually flattening and tightening of the tummy and lifting of the hips/thighs and buttocks. The tummy tuck component of the procedure is performed in similar fashion as a full tummy tuck with liposuction where needed, and muscle tightening to help flatten the tummy.

Who is a candidate for a Body Lift?

Patients with a lot of excess skin and soft-tissue laxity are good candidates for the Body Lift procedure. Often, candidates for a body lift have had some degree of weight loss either from bariatric surgery or from regular dieting.

Where are the incisions?
The incision is hidden in the underwear line around the waist and is very well tolerated. In certain circumstances, an additional vertical incision is made in the middle to reduce the laxity from side-to-side. This is done when there is a previous vertical incision and/or there is tremendous amount of laxity and the patient wants maximum correction and tightening.

All the best,

Thursday, August 27, 2009

Lip Augmentation

How can lips be made fuller, younger looking?

Recently I was interviewed by a local new station regarding the new PermaLip implant. See video in the side bar) The PermaLip implant is a soft silicone implant that is placed under local anesthesia in about 30 minutes. The benefits of the PermaLip implant is that it is easy to place, exchange, or remove. It feels soft and once it is placed no further scheduled fillers need to be used.

Other options for achieving fuller lips include using hyaluronic acid fillers (juvederm, restylane, etc), injecting fat, or placing various types of material including fascia, skin, and goretex.

All the procedures have advantages. The PermaLip implant is quick, easy, they look great, and they feel natural. Hyaluronic acid fillers also look and feel great but require priodic injections since the fillers go away. Fat grafting can be a good method to get fuller lips but requires a donor site and some of the fat tends to go away.

The best product or procedure varies for each patient. If temporary fillers give you the look you like than a permanent implant such as the PermaLip or fat grafting is often a good long term choice.

All the best,

Wednesday, August 12, 2009

Breast Augmentation

Breast Augmentation

Breast augmentation goes by many names. Commonly used terms include breast enhancement, breast enlargement, and of course boob job. All of these terms refer to the same basic idea of using an implant (or fat grafting in certain circumstances) to increase the size and improve the shape of breasts.

To understand breast augmentation it helps to brake it down into the type of implant, incision location, and level of tissue placement. The list of each is shown below and a more comprehensive discussion follows.

Implant types
Smooth shell
Silicone (gummy bear)
Smooth shell
Textured shell
Silicone (form stable)
Textured shell only

Incision location
Peri-areolar (at the border of the areola and breast skin)
Trans-axillary (through the arm pit)
Inframmamary (at the breast fold/under the breast)
Trans-umbilical (aka TUBA, through the belly button)

Sub-glandular (under the breast gland)
Sub-fascial (under the covering on top of the muscle)
Sub-pectoral (under the muscle)

The goal of any breast augmentation is to match the patients goal of what they want their breasts and body to look like. This is important because there is a wide range of patient desire regarding the aesthetic appearance of a breast. Some patients want very modest results, wishing to avoid any suspicion of that a cosmetic breast procedure was performed. On the other end of the scale there are patients who want the very largest breast possible, maximizing volume and cleavage. Of course, most patients fall somewhere in between. This issue of personal choice is important because it will guide the selection process of implant type, incision location, and placement.

Breast implant type
The most natural feeling breast implant type in my opinion as well as the opinion of my staff and patients are silicone (gumy bear type). Therefore, my preference for breast implant type is usually either textured silicone or smooth wall silicone. I always present the pros and cons of each implant type and allow the patient to decide. Most patients agree that silicone is the most natural to feel. With the reassurance that silicone implants are just as safe as saline implant, the majority of patients choose silicone. I will use saline implants in a handful of situations including patient preferrence, placement via the belly button (TUBA, see above), placement through a very small areola of a large final volume implant, and occassionaly placement of a large final volume implant via the arm pit (transaxillary). The reason for use of saline implants in these situations is simply that a silicone gel implant requires a slightly larger opening. The difference between smooth wall and textured wall breast implants is negligible. I often use textured for the potential added benefit of less scarring internally as well as a more even feel as the breast tissue and the implant tend to more together more as a result of the textured shell. The last type of breast implant is the form stable breast implant. This implant is also made of silicone gel but the gel is more cohesive and therefor slightly firmer in terms of feel. These implants are still restricted for "reconstructive" use, but periodically they are used for cosmetic breast augmentation by some plastic surgeons. They have a nice shape but are firmer. They also require a slightly larger incision than the gummy bear implants.

Incision location
The location of the incision for placement of the breast implant is determined by patient preference but also by implant type and implant size.

The inframmamary incision (breast fold incision) allows the surgeon a great deal of control and access to shape the breast. Both saline and silicone breast implants can be placed via the inframmamry incision.

The trans-axillary incision (through the arm pit) can be used with either the saline or silicone implant but larger silicone implants become exceedingly difficult to place via this incision and therefore implants larger than about 400cc placed via the arm pit will likely be saline. The arm pit incision can also offer good visualization for the surgeon when an endoscope is used.

The peri-areolar incision can be used with either saline or silicone breast implants. Again, if the areola is particularly small and/or the implant is particularly large it may be difficult to use a silicone implant. How small the areola is or how big the silicone implant is before saline implant must be used needs to be judged on a patient by patient basis. The peri-areolar incision is especially useful if the areola is to be made smaller during the same procedure or the breast will also be "lifted" (mastopexy) during the same procedure. The peri-areolar incision is almost always the incision of choice for female bodybuilders since that incision is the oncly incision always hidden during body building exibitions.

The trans-umbilical incision is always used with saline breast implants. It is very difficult, or nearly impossible to get a silicone implant through the belly button incision and up to the breast area, especially without the risk of damaging the implant.

Implant placement

As listed above, implants can be placed underneath the breast tissue, under the covering of the fascia on top of the muscle, or under the muscle. If saline implants are chosen and especially if the patient is very thin, the implant should be placed under the muscle. In all other circumstances, I recommend the placement of silicone implants underneath the fascia on top of the muscle. This accomplishes three things. First the recovery is significantly faster and easier. Most of the pain associated with breast augmentation is secondary to the muscle being cut. Placing the implant on top of the muscle avoids this issue and makes recovery much easier. The other benefit of placing the breast implant in the subfascial plane is that the breast will be softer earlier and when all of the healing has been completed. Finally, placing the breast implant in the subfascial plane avoides "breast animation". Breast animation is the term used to describe movement of the breast when the arms are used. Breast animation occurrs when the muscle is placed under the pectoralis muscle. When the arms are used during regular daily activities or excercise the pectoralis muscle is naturally activated. When the muscle moves the breast implants move, usually in an out and up direction. This can be quite dramatic at times and can be very bothersome and unattractive for the patient as well as the patients partner.

I hope this helps. More to come in the near future about breast augmentation.

All the best,

Sunday, April 26, 2009

Buttock Fat Grafting

What is buttock fat grafting?

Buttocks fat grafting is the process of removing fat from other areas of the body such as the abdomen, lower back, hips, and thighs and placing it in the buttock area. The fat is harvested or removed by a method similar to liposuction and it is transferred or grafted to the buttock area after processing. The entire event occurs in the operating room (or procedure room for small areas).

When is buttocks fat grafting performed?

It is performed most commonly for augmentation, or increasing the size of the buttocks, as well as shaping and correcting contour irregularities.

What are the benefits of fat grafting?

It is your own tissue. The fat that is grafted into the buttocks area forms new blood supply. In doing so it changes as your body changes. It feels soft and unform without the notion that it is something distinct from the surrounding tissue. There is of course the added benefit of improved contour in the areas where the fat has been harvested from.

What are the drawbacks of buttocks fat grafting?

Buttocks fat grafting requires excess fat in other parts of the body. Some women, especially those that feel their butt is too small, are usually fairly thin and the amount of fat needed may not be readily available. These patients are better candidates for buttock augmentation using an implant (see next entry for buttock implants). Buttocks fat grafting should not be used to correct buttock ptosis (saggy buttock). In these cases, a buttock lift with or without augmentation should be perfomed.

What is the recovery time like?

Patients who have undergone buttock fat grafting have uniformily been suprised at the low level of discomfort. Usually, the areas where fat has been harvested is felt more than the buttock area. Restrictions involve avoiding vigorous activity or prolonged sitting especially on non-padded surfaces.

Stay tuned for buttocks augmentation using implants as the next blog entry.

All the best,

Dr. Repta
Phoenix/Scottsdale Plastic Surgeon

Tuesday, March 10, 2009

Thursday, January 15, 2009

Buttock Lift

What is a buttock lift?

Any procedure that removes excess skin and soft-tissue laxity to correct or improve the shape and contour of the buttocks can be referred to as a buttock lift.

As with any "lift" procedure--whether it is a breast lift, face lift, etc.--the amount of skin and soft tissue laxity that is present determines the extent of the incision and subsequent length of scar that is needed to correct the laxity and achieve the best contour possible.

Where is the scar located for a buttock lift?

The short answer is wherever the patient prefers it. The best location, however, is at the level and in the shape of the underwear line. Imagine a pair of appropriately sized and located underwear that are worn snug. The indentation of the underwear line gives a good idea where the final buttock lift incision should lay.

What is the recovery process like?

Surprisingly straightforward. Most of my patients who have undergone combination procedures including a buttock lift have reported that the recovery process was fairly easy with more of a general feeling tightness rather than significant discomfort.

No special restrictions are needed. Patients are allowed to sit and sleep on their back. I recommend using plenty of cushion and minimizing sitting in one place or position for extended periods of time.


The buttock lift procedure can be performed in a variety of ways but (no pun intended) the general idea is to remove the excess skin and soft-tissue laxity by resection tissue using an incision at the level of the top portion of the underwear line. It can be combined with buttocks augmentation or with a body lift (circumferential abdominoplasty). The recovery process is fairly straightforward.

All the best,

Dr. Repta
Phoenix/Scottsdale Plastic Surgeon

Tuesday, January 6, 2009

Buttocks Contouring

In an earlier post we discussed buttocks fat grafting; the plasti sugery procedure designed to increase the size and shape of the buttocks through the method of removing fat from unwanted areas and grafting (injecting) the fat into the buttocks. Buttock fat grafting is actually a part of the the larger concept of buttock contouring. As with all cosmetic plastic surgery procedures, the right procedure should be tailored to each individual for their specific needs and goals.

Since the buttock area is a significant part of human health and sensuality, we will disuss in greater detail, over the next few weeks, the concept of buttock contouring.

What is buttocks contouring?

Buttocks contouring is the general term used to describe plastic surgery procedures that are used to improve the shape, size, and appearance of the buttocks. These collect group of procedures include:

-Fat grafting

We have covered buttock fat grafting in an earlier post. Later this week we will discuss buttock lift. This procedure is designed to correct skin and sofy-tissue laxity. It may be used alone or in conjunction with other body contouring and/or buttock contouring procedures.

Stay tuned for the buttocks lift procedure later this week.

All the best,

Dr. Repta
Phoenix/Scottsdale Plastic Surgeon