Wednesday, May 12, 2010

Dont Sweat It

The technical term for excessive sweating is hyperhydrosis. This can be seen anywhere on the body but usually is most problematic when it occurs on the hands, face, and in the underarm area (axillary region). The most common area for complaints is in the underarm area.

There are many women and men who either have excessive underarm sweating or would prefer to not have to wear antiperspirant or cannot tolerate antiperspirant. Traditional methods of reducing under-arm sweating revolved around the injection of botox. While this is still a reasonable treatment option the recurring cost and need for multiple injections have spurred patients to ask for better solutions. My answer to these patient requests has resulted in a permanent solution.

The procedure is called SASS underarm TM (small access subdermal shaving). It can be performed under local or general anesthesia in about an hour. The majority or all of the underarm sweat glands and often hair follicles are removed through a small incision about the width of a dime. Recovery and down-time is relatively simple, involving a simple compression dressing for a few days.

All the best,

Sunday, April 11, 2010

Tummy Tuck Scars

A frequent concern of patients considering a tummy tuck is the final scars. Rightfully so, all cosmetic procedures involving removing large amounts of skin and soft-tissue will need to have some type of scar. The two-part question that prospective tummy tuck patients should consider is:

How will the final scar look and feel when I am nude? And, will it the scar be visible when a I am wearing a two piece bikin, low rider jeans, underwear, etc?

Since we can all agree that a scar will be present after a tummy tuck the the answer to the above questions should help to alleviate most concerns about scars.

How will my Tummy Tuck Scars look and feel when I am nude?

It is my experience and that of my colleagues that tummy tuck scars uniformly heal thin, without keloid or hypertrophic qualities. A keloid scar is one that becomes so thick that the borders of the scar are beyond the area of the initial incision. A hypertrophic scar is a scar that heals with above normal amount of thickness but remains overlying the area of the incision. Hypertrophic scars are bad, keloid scars are really bad. Quite frankly I have never seen keloid scars resulting from a tummy tuck procedure either from my own patients or from patients who have had their surgery elsewhere. Hypertrophic scars usually occur from one of several factors including: beyond the limit excessive tension on the closure, inadequate suturing, infection, or otherwise poor healing resulting from medical issues or insufficient blood supply. With current knowledge, skills, and technology, hypertrophic scars from the tummy tuck procedure should be a very rare event. Correcting a hypertrophic scar starts with identifying the cause and revising the scar. It is usually a very straight forward procedure that frequently can be performed under local anesthesia with or without sedation. In most cases a drain is not needed and in a good number of cases an abdominal binder is not needed as well.

Other types of non-ideal tummy tuck scars include very thin and wide scars, asymmetric scars, and discolored scars. Very thin and wide scars usually indicate that the stronger connective tissue underlying the skin did aid the skin in healing properly. This can be he result of poor tissue quality or improper repair of this stronger, deeper tissue. Revision of these scar usually involves removal of the thin scar and proper repair of the thicker deeper underlying tissue. Asymmetric tummy tuck scars are usually the result of the tummy tuck design although if one side of the abdomen has previous scars then asymmertic healing can also occur. Tummy tuck scars that are either too light or too dark can be corrected through revision or through non-surgical means. Dark scars can be lightened with certain creams, light scars can be corrected with something called medical trepenation. Some of my research during my training focused on the treatment of low pigment scars and this process seemed promising.

How will my tummy tuck scars look when I am wearing certain types of clothes including a bikini, low-rider jeans, and mid-drift bearing shirts?

This is a particular passion for me in terms of the tummy tuck procedure. What is the point of getting a tummy tuck if you cannot show your tummy afterwards without people noting you have had surgery. In order to accomplish this the final incision lines of a tummy tuck must be hidden. The lower incision of the tummy tuck must be kept very low in the panty line (except for reverse tummy tuck where it should be hidden in the breast fold) and the belly button incision must be hidden within the belly button.

To accomplish this it is very important to design the tummy tuck procedure properly. The location of these incisions in the end is almost solely dependent on the design and execution of the tummy tuck procedure by the plastic surgeon. Correction of high or visible tummy tuck scars often requires more than just a tummy tuck scar revision. It frequently involves a complete tummy tuck repair sometimes also known as a complete tummy tuck re-do. This is essentially the full tummy tuck redone from beginning to end. For more information on this, please see my previous post on tummy tuck repair.

In terms of tummy tuck scar care, scar care creams such as Miderma or Scarguard can help but only if everything discussed above has been properly addressed.

In summary, anyone that is a good candidate for a tummy tuck must decide if it is worth it to them to trade a better looking tummy for a scar. This should be easily answered "Yes" if there is confidence about the appearance and location of the final scars as discussed above.

All the best,

Thursday, February 4, 2010

Tummy Tuck Repair

What is Tummy Tuck Revision?

Many of the emails and questions I receive are from individuals who have had a tummy tuck and now are wondering how to fix or improve their tummy tuck result. The terms used for the group of procedures used to improve tummy tuck results includes "Tummy Tuck Revision", "Tummy Tuck Repair", and "Tummy Tuck Re-do". Regardless of which term we use we are communicating the same thing: surgical and non-surgical methods of improving the appearance of the abdomen and surrounding areas of the body following a tummy tuck. There are a handful of issues that can arise following a tummy tuck which can result in dissatisfaction with the appearance of the abdomen. A list of the more commonly encountered issues following a tummy tuck procedure is listed below:

List of potential tummy tuck issues:

Poor scars: Tummy tuck scars can be improved. Wide scars can be made thin by simple scar revision. Scars that are too high can be lowered by scar revision as well; however significant lowering of scars often requires full tummy tuck revision.

Belly button/umbilicus: There are many potential problems with the appearance of the belly button following a tummy tuck. Visible scars, a belly button that is asymmetric, too much fullness surrounding the belly button, a belly button that is either too small or too large or whose shape is unappealing can be corrected. Sometimes the solution can be fairly straightforward and even accomplished in the office under local anesthesia. Other belly button problems may require more extensive repair such as re-tightening of the abdominal wall and revising the tummy tuck to allow complete rejuvenation of the umbilicus.

Excess fat: Visible amounts of fat especially near the belly button and above the pubic bone can detract from the aesthetic result of a tummy tuck. Liposuction is often a great solution if there is not excess skin laxity. Localized pockets of fat can be performed under tumescent (local) anesthetic, more extensive liposuction is usually performed under general anesthesia.

Excess skin laxity: There are various reasons to have residual skin laxity following a tummy tuck. If the amount of excess skin laxity is relatively minor this can be corrected as part of a scar revision. Larger amounts of residual skin laxity may benefit from a formal tummy tuck revision or from the addition of a complimentary tummy tuck procedure such as a reverse tummy tuck following a traditional full tummy tuck.

“Dog-ears”: This term applies to excess skin and fat at the sides of the tummy tuck incision. They look like triangles of soft-tissue and are uniformally hated by any patient that have them. This is a result of several issues often it is a combination of too much laxity for the given tummy tuck procedure and/or the design of the incision and resection of the tummy tuck tissue. Correction of this problem can be accomplished in one of two ways. Either the excess soft-tissue is removed and the scar is lengthened thereby improving the overall appearance of this area, or the previous tummy tuck procedure is extended into a circumferential tummy tuck. This has the added benefit of improving the laxity that may exist at the side of the hips as well as in the buttock area for some patients.

Uneven surface: The surface of the abdomen should be smooth and natural. Lumps and bumps detract from the overall result and should be addressed. Small irregularities can be addressed with liposuction, larger irregularities should be addressed through a methodical assessment and correction usually requiring a formal revision tummy tuck.

Pseudobursa: A pseudobursa is a pocket of extra thick scar tissue that can form under the abdominal soft tissue following a tummy tuck. The most common area for pseudobursa formation is just above the waistline incision in the middle. This is the most gravity dependant area so it is naturally the most likely area for pseudobursa formation to occur. A pseudobursa can also develop just above the belly button. The presence of the belly button stalk and the surrounding tissue can form an area for a seroma to accumulate and for a pseudobursa to form. Small or relatively thin pseudobursa, if palpable or visible can be reduced by thorough liposuction and drain placement, most pseudobursas, however, need to be removed surgically during a revision tummy tuck for definitive correction.

All the best,

Dr. Remus Repta