tag:blogger.com,1999:blog-81403167917073919282024-02-01T21:54:05.871-08:00Tummy Tuck & Body ContouringDedicated to providing accurate, meaningful, and up-to-date information on the tummy tuck procedure, body contouring, and cosmetic plastic surgery in general.Anonymoushttp://www.blogger.com/profile/17525644549512347584noreply@blogger.comBlogger42125tag:blogger.com,1999:blog-8140316791707391928.post-70467890752597854662013-11-28T11:17:00.001-08:002013-11-28T11:17:20.308-08:00Bikini Ready Tummy Tuck Procedure <div dir="ltr" style="text-align: left;" trbidi="on">
What is a Bikini Ready Tummy Tuck?<br />
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A Bikini Ready Tummy Tuck is an abdominal and waist contouring procedure designed to slim, tighten, and rejuvenate the entire waist area. It is designed to be performed in one procedure and to deliver the maximum results to allow the patient to be......you guessed it...Bikini Ready.</div>
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The procedure is individualized to each patient and often includes liposuction of the lower back, flanks, and abdomen as well as a full tummy tuck. Occasionally the fat removed is used to replenish volume that has diminished over time in other areas such as the buttocks and lateral thighs.</div>
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The Bikini Ready Tummy Tuck procedure requires thorough discussion and planning between patient and plastic surgeon as well as expertise in body contouring plastic surgery and tummy tuck surgery in general. The procedure has evolved in my practice over time through advanced learning, the desire to provide better results, and through careful attention to what my patients have communicated to me.</div>
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Below is one example of what a Bikini Ready Tummy Tuck procedure can accomplish. The link below the photo will take you to the full set of before and after photos for this patient.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJ-w5XqDG-esMxV28hrC-QS3GNrW4QiC0uDqpWG3se2gC1ZpsLWKG2rezZDmGAxz01cIcWIRc0911YQ8uWCttJGT0_SRxf3tn9zGTN692anblazd7pEKqS7uVlGlaBC4h-XyyRV_kFn_Y/s1600/front+jpeg.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="178" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJ-w5XqDG-esMxV28hrC-QS3GNrW4QiC0uDqpWG3se2gC1ZpsLWKG2rezZDmGAxz01cIcWIRc0911YQ8uWCttJGT0_SRxf3tn9zGTN692anblazd7pEKqS7uVlGlaBC4h-XyyRV_kFn_Y/s320/front+jpeg.jpg" width="320" /></a></div>
http://www.scottsdaletummytuck.com/photo-gallery/details.cfm?ID=344&StartRow=1<br />
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All the best,<br />
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Dr. Remus Repta</div>
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Unknownnoreply@blogger.com30tag:blogger.com,1999:blog-8140316791707391928.post-90165448411703578802013-10-12T10:54:00.002-07:002013-10-12T10:54:40.030-07:00Tummy tuck pain<div dir="ltr" style="text-align: left;" trbidi="on">
<b>Tummy tuck pain: What to expect and how to make the best of it.</b><br />
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Many men and women are candidates for a tummy tuck procedure after either significant weight loss or after child birth. One of the main issues that many patients state made them wait to get a tummy tuck procedure is the concern of the pain and recovery associated. Since knowledge is power lets discuss what one can expect following a tummy tuck as well as what can be done to make that recovery experience a little better.<br />
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<b>How much pain should on expect after a tummy tuck?</b><br />
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Lets face it, a well performed tummy tuck with abdominal muscle tightening, liposuction of the flanks, and removal of the excess abdominal loose skin will result in some discomfort. Most of the pain or discomfort associated with a tummy tuck is no related to the incision, however. Once an incision is sealed it tends not to cause too much discomfort. Most of the discomfort that patients report is often from the abdominal wall tightening. Abdominal wall tightening does <b>not</b> involve cutting muscles. This is an important thing to know and remember because part of "pain" is mental. If you feel like you have done the most intense abdominal workout and know that nothing bad is happening you will not have the fear component associated with your discomfort and will know that it is largely tightness and soreness that will get better each day.<br />
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On a scale from 1-to-10, most patient will rate a tummy tuck in the 6-8 range the first week, 3-5 range the second week, and less thereafter. This of course variable from patient to patient and I do consistently get several patients each month that are smiling, seem comfortable, and largely report that its not as bad as they thought it would be even in the first week after their tummy tuck. Most patient however, do find the first week a little challenging but its that first week that is the hardest.<br />
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<b>How to make the best of the tummy tuck recovery?</b><br />
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Knowing what to expect, what is happening, and not being afraid of the unknown are key. A trusting relationship with your plastic surgeon will be important. I tell my patients that I will always be looking out for anything that can signal healing issues. Until then, just know that everything is healing well and there is nothing to fear.<br />
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Most of what can be done to make this process better is in the surgeons hands. In addition to education numbing medication and proper dressings can make a difference. Placement of long acting numbing medication deep in the tissues can help a lot in the first few days after a tummy tuck. Some surgeon also use a pain pump routinely. I leave the pain pump as an option for my patients as some patients do not want either the extra cost or the extra tube and bulb that goes along with it. A properly placed abdominal binder and drain can also help reduce the discomfort after surgery. Finally, pain medications. The right combination of pain medications can help make the recovery process seem less intense. Both narcotic and non-narcotic medications as well as muscle relaxer type medications can be helpful.<br />
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A few other details that may be of help are: having a recliner to sleep in and using a toilet seat booster to help when having to use the bathroom. Of course, having a supportive friend or family member to help you through this journey is also recommended.<br />
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So,......tummy tuck surgery is intense but when performed properly the discomfort of the recovery process is well worth the final results. There are a few things that both you and your plastic surgeon can do to make this process better as discussed above and education of what is and is not occurring (knowledge is power) is right up there with the most important of them.<br />
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Good luck on your tummy tuck journey.<br />
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All the best,<br />
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Dr. Remus Repta<br />
Phoenix/Scottsdale, AZ<br />
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Unknownnoreply@blogger.com18tag:blogger.com,1999:blog-8140316791707391928.post-2983296048753264112013-10-03T13:19:00.002-07:002013-10-03T13:19:46.740-07:00Published chapter in new plastic surgery textbook<div dir="ltr" style="text-align: left;" trbidi="on">
Hello everyone.<br />
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I wanted to share my recent chapter publication in the new Grabb & Smith's plastic surgery textbook. The textbook is now in its seventh edition and has consistently served as a premiere reference for plastic surgeons in training as well as those already established. The chapter is Lower Body Lift & Thighplasty and covers the indications, techniques, and photographic documentation of the key parts of a lower body lift and thighplasty. As some of you may know, a lower body lift is designed to correct circumferential (all the way around) waist laxity often associated with significant weight loss. It can be thought of as a buttock lift and back of thigh lift in the back, abdominoplasty (tummy tuck) in the front, and a thigh lift on the side.<br />
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Thank you,<br />
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Remus Repta MD<br />
Phoenix/Scottsdale, AZ<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiu-CDVq_gTTHb-R8pIS5SFxaIG6Mmw0ohx8wcfuY1V03X3vvFj3jPc6dE1JzeyAZRMFWx4oP7aU7miLPcvFq-0FjoPGDy0j6RKnnep6y92tb8dBukrWW3Ql2QYtQoH-ZlDfIuZueWO-Q8/s1600/GrabbSmithCover.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiu-CDVq_gTTHb-R8pIS5SFxaIG6Mmw0ohx8wcfuY1V03X3vvFj3jPc6dE1JzeyAZRMFWx4oP7aU7miLPcvFq-0FjoPGDy0j6RKnnep6y92tb8dBukrWW3Ql2QYtQoH-ZlDfIuZueWO-Q8/s320/GrabbSmithCover.jpg" width="261" /></a></div>
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Unknownnoreply@blogger.com6tag:blogger.com,1999:blog-8140316791707391928.post-54020361946169864942013-09-11T12:41:00.001-07:002013-09-11T12:41:36.435-07:00Achieving a natural tummy tuck result<div dir="ltr" style="text-align: left;" trbidi="on">
Getting a tummy tuck does not mean that your abdomen and waist should look like you've had something done. An ideal tummy tuck result for me is one where the abdomen and waist look as good as they can without appearing that there has been surgery performed. This means that the incision looks great and its well hidden, the belly button appears natural, and the tummy tuck results blend into the flanks and remainder of the waist. <br />
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For a quick overview of what I believe a natural appearing tummy tuck result can be please take a look at this brief video clip I have put together.<br />
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<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/wHLm8h5SMBA?feature=player_embedded' frameborder='0'></iframe></div>
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All the best,<br />
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Dr. Remus Repta</div>
Unknownnoreply@blogger.com5tag:blogger.com,1999:blog-8140316791707391928.post-85456096449089210612013-09-02T10:48:00.001-07:002013-09-02T10:48:41.245-07:00Mommy Makeover<div dir="ltr" style="text-align: left;" trbidi="on">
<b>What is a Mommy Makeover?</b><br />
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A mommy makeover is a term used to describe a procedure or group of procedures designed to improve or reverse the effects that having children has created on the body. Most commonly, a mommy makeover is a tummy tuck and either a breast augmentation (breast implants) or a breast aumentation and breast lift.<br />
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<b>Does a mommy makeover look natural?</b><br />
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It can. When properly designed a mommy makeover procedure can produce a natural and aesthetically pleasing result. See the video below.<br />
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All the best,<br />
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Dr. Remus Repta<br />
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<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/YlkIAsOgQ0w?feature=player_embedded' frameborder='0'></iframe></div>
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Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-8140316791707391928.post-36371453017290824972013-08-22T19:07:00.001-07:002013-08-22T19:07:23.413-07:00Ethnic tummy tuck<div dir="ltr" style="text-align: left;" trbidi="on">
<b>Does ethnicity (race) factor in when designing a tummy tuck procedure?</b><br />
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The short answer is yes. A tummy tuck is designed to fit the individual and all of the individuals characterirstics including skin type, amount of fat, shape and size of pelivis and hips, etc. Accomplishing a balanced, natural, and aesthetically pleasing tummy tuck result requires taking into account all of these characteristics as well as the patients desired goal.<br />
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Below is a short video showing how ethnic differences can be incorporated into a great tummy tuck result. Enjoy!<br />
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<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.youtube.com/embed/xlIPJUq9vGw?feature=player_embedded' frameborder='0'></iframe></div>
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Unknownnoreply@blogger.com6tag:blogger.com,1999:blog-8140316791707391928.post-35769956000438773322013-07-24T16:51:00.000-07:002013-07-24T16:51:13.347-07:00Dr. Repta before and after photo book <div dir="ltr" style="text-align: left;" trbidi="on">
Hello everyone,<br />
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I've completed and published a short 60 page book containing information about who I am and what I do including before and after photos of some of my patients.<br />
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Click on the link below to access a high resolution copy of my before and after book.<br />
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All the best,<br />
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Dr. Remus Repta<br />
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<a href="http://www.drrepta.com/photo-book.pdf">http://www.drrepta.com/photo-book.pdf</a></div>
Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-8140316791707391928.post-25004620360323659052013-05-15T09:26:00.000-07:002013-05-15T09:26:05.801-07:00Prophylactic mastectomy and breast reconstruction options<div dir="ltr" style="text-align: left;" trbidi="on">
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The most prominent recent news related to breast cancer and breast reconstruction has been the mainstream story that Angelina Jolie has been diagnosed with the BRCA positive gene and that she underwent bilateral prophylactic mastectomy (removal of both breast tissue mounds) as well as breast reconstruction. Her generous sharing of information related to this event in her life and that of her family has generated a lot of discussion of breast cancer detection, breast cancer treatment, and breast reconstruction.<br />
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Along with my plastic surgery colleagues at Advanced Aesthetic Associates, I founded Breast Resource Arizona (<a href="http://breastresourcearizona.org/">breastresourcearizona.org</a>) as a source of information for breast health and breast cancer particularly aimed at local women and their families. Within the breastresourcearizona.org site there is information that addresses many of the common questions that have arisen from the recent Angelina Jolie story including the BRCA gene, prophylactic mastectomy, and breast reconstruction options.<br />
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Breast cancer detection, treatment, and reconstruction have made tremendous clinical progress over the last decade and it continues to make advancements each year with the help of courageous patients and hard working surgeons and researchers.<br />
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All the best,<br />
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Dr Remus Repta<br />
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Unknownnoreply@blogger.com3tag:blogger.com,1999:blog-8140316791707391928.post-46744150644767023702012-12-09T14:21:00.002-08:002012-12-09T14:21:42.053-08:00Tummy tuck repair<div dir="ltr" style="text-align: left;" trbidi="on">
What can be done to repair a tummy tuck?<br />
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I have covered some of the issues that can occur with a tummy tuck in prior posts and wanted to focus a little more on the idea of starting over again with a tummy tuck repair.<br />
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There are a handful of issues that can detract from an ideal tummy tuck result including:<br />
-poor tummy tuck scar quality (thick scar, irregular scar)<br />
-poor scar location (high tummy tuck scar)<br />
-poor belly button appearance (belly button too big, scar visible, poor belly button appearance)<br />
-too much residual fat<br />
-too much residual skin<br />
-insufficient abdominal wall tightening<br />
-pseudobursa<br />
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Each of these issues can be addressed independently, however, in my experience I have found that frequently more than one of these issues exists and the best chance at an excellent result is often a full tummy tuck repair--essentially redoing the entire tummy tuck. Although it is desirable to perform a smaller procedure a full tummy tuck repair often has the best chance of delivery the best result and really giving the patient the tummy tuck contour and appearance that they envisioned.<br />
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A full tummy tuck repair involves a careful assessment of the issues that have contributed in a less than ideal tummy tuck result and then an equally careful plan of correcting the issues and improving all of the components than will provide an excellent tummy tuck result. In the end, I usually perform additional liposuction, lowering of the scar, removal of pseudobursa and foreign bodies, additional tightening of the abdominal wall, repair of the belly button, and proper closure of the incision line.<br />
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Below is a link from my website that represent some of what can be accomplished with a full tummy tuck repair.<br />
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http://www.aaaplasticsurgery.com/photo-gallery/details.cfm?ID=119&StartRow=6<br />
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All the best,<br />
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Dr Remus Repta<br />
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Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-8140316791707391928.post-57183818657365685862012-02-01T16:22:00.000-08:002012-02-01T16:23:50.411-08:00Breast Augmentation Revision<p class="MsoNormal"><b><span style="font-size:12.0pt;line-height:115%">Breast Augmentation Revision<o:p></o:p></span></b></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%">Breast augmentation is one of the most common plastic surgery procedures performed both in the United States as well as worldwide. We have discussed the specifics of breast augmentation in previous blog entries including types of implants available, incision location options, and whether the implants are placed on top of the muscle or below the muscle. With so many breast augmentation procedures being performed and the number of variables involved as mentioned above, it is not unreasonable to expect some breast augmentation procedures to require or benefit from revision surgery.<o:p></o:p></span></p> <p class="MsoNormal"><b><span style="font-size:12.0pt;line-height:115%">What is breast augmentation revision?<o:p></o:p></span></b></p> <p class="MsoNormal"><span style="font-size:12.0pt;line-height:115%">In general, a revision procedure is a procedure designed to improve or correct an undesirable characteristic of the initial procedure. Therefore, breast augmentation revision is repair or correction of any of the unfavorable characteristics that may be seen following breast augmentation. These may include:<o:p></o:p></span></p> <p class="MsoNormal"><b><span style="font-size:12.0pt">1) Implant related problems of breast augmentation:<o:p></o:p></span></b></p> <p class="MsoNormal"><span style="font-size:12.0pt">a) implant too big<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt">b) implant too small<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt">c) implants not the ideal size difference for symmetry<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt">d) implant diameter too small<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt">e) implant diameter too big<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt">f) implant projection too small<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt">g) implant projection too big <o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt">h) desire for silicone instead of saline (and vice versa)<o:p></o:p></span></p> <p class="MsoNormal"><b><span style="font-size:12.0pt">2) Breast pocket related problems of breast augmentation<o:p></o:p></span></b></p> <p class="MsoNormal"><span style="font-size:12.0pt">i) breast pocket too wide on the side (aka laterally, this is most common). <o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt">j) breast pocket too wide near the cleavage causing either too much cleavage or symmastia (inner breast borders touch)<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt">k) breast fold too low<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt">l) breast fold too high<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt">m) breast fold shape not ideal<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt">n) upper breast pocket dissected to much (breast implant migrates toward the clavicle when laying down)<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt">o) breast pockets not symmetric<o:p></o:p></span></p> <p class="MsoNormal"><b><span style="font-size:12.0pt">3) Breast tissue problems with breast augmentation<o:p></o:p></span></b></p> <p class="MsoNormal"><span style="font-size:12.0pt">p) breast tissue too thin and implant visibility or palpability is an issue<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt">q) animation. Breasts move too much when pectoralis muscle is flexed<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt">r) capsule contracture. The capsule around the breast is excessively thick resulting in firm and/or painful breasts.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt">Over the next few weeks I will cover the breast augmentation revision procedures involved in every one of the breast augmentation revision problems listed above. I will designate the topic by name as well as its corresponding number-letter combination, i.e. 3p-Breast tissue too thin.<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt"><o:p> </o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt">All the best,<o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt"><a href="http://www.aaaplasticsurgery.com/plastic-surgeons/dr-repta.cfm">Dr Remus Repta</a><o:p></o:p></span></p> <p class="MsoNormal"><span style="font-size:12.0pt">Phoenix/Scottsdale, AZ<o:p></o:p></span></p>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-8140316791707391928.post-3439670513454986142012-01-29T07:26:00.000-08:002012-01-29T07:31:27.709-08:00Combined breast augmentation and breast lift<p class="MsoNormal">I have recently returned (not without protest) from a plastic surgery conference on the island of Tortola in the Bahamas where I presented my experience with performing combined subfascial <a href="http://www.aaaplasticsurgery.com/plastic-surgery/breast-augmentation.cfm">breast augmentation</a> and <a href="http://www.aaaplasticsurgery.com/plastic-surgery/breast-lift.cfm">breast lift</a> and I thought I would do a quick summary on the blog for everyone else.<o:p></o:p></p> <p class="MsoNormal">Everyone knows quite a bit about breast augmentation. There is the understanding that there exists saline breast implants as well as silicone or “gummy bear” breast implants. It is also commonly understood that implants can be placed on top of the muscle or under the muscle and that one option for placing an implant on top of the muscle is called subfascial breast augmentation. This technique of breast augmentation has been proven to be safe, effective, and to give great results if performed in the right group of patients.<o:p></o:p></p> <p class="MsoNormal">Breast lift procedures are any surgical procedure that is used to reshape the breast. The placement of the incision or incisions may vary depending on the need of the patient and the overall effect of the breast lift may also vary, but the common idea is that a breast lift does not remove breast tissue—that is called a breast reduction—and does not add any volume to the breast—that is called a breast augmentation. There are two basic categories of breast lifts.<o:p></o:p></p> <p class="MsoListParagraphCxSpFirst" style="text-indent:-.25in;mso-list:l0 level1 lfo1"><!--[if !supportLists]-->1)<span style="font:7.0pt "Times New Roman""> </span><!--[endif]-->Breast lifts that are designed to lift the areola higher up on the breast mound<o:p></o:p></p> <p class="MsoListParagraphCxSpLast" style="text-indent:-.25in;mso-list:l0 level1 lfo1"><!--[if !supportLists]-->2)<span style="font:7.0pt "Times New Roman""> </span><!--[endif]-->Breast lifts that are designed to reshape and reposition the lower breast tissue higher by reducing laxity through removal of excess skin.<o:p></o:p></p> <p class="MsoNormal">Of course, there are a large number of women who need both a breast augmentation to replenish volume as well as a breast lift to address the shape and position of the areola and/or breast tissue. About 10 years ago, there was still a sizeable amount of discussion about the safety and efficacy of performing a breast augmentation and breast lift at the same time. Over this period the amount of literature that has been presented to support the safety of performing an augmentation and lift at the same time has been considerable and today most surgeons (this one included) perform the vast majority of their breast augmentation and breast lift procedures together at the same time. Performing combined subfascial breast augmentation and breast lift is now the focus of a little skeptical attention in the plastic surgery community and my research has been an attempt at providing information on the safety and efficacy of doing so.<o:p></o:p></p> <p class="MsoNormal">In essence, the take home point of my research is that combining subfascial breast augmentation and breast lift is definitely safe—as I have not had any complications, and it is effective in that my patients have been overwhelmingly happy with their results. Early long term result—about 1-2 years after surgery—have shown that the combination of the two procedures is long lasting as well. There are some patients however that would likely be better served by placing the implant under the muscle along with their breast lift procedure and these patients are those that are both very thin as well as contain significant breast soft-tissue laxity. <o:p></o:p></p> <p class="MsoNormal">Anyways, I will keep following all of my patients out for longer long term result and report back again. As of now, I think we can begin to conclude, based on the information coming in that subfascial breast augmentation performed at the same time as breast lift surgery is a safe and effective option when patients are selected properly.<o:p></o:p></p> <p class="MsoNormal">All the best,<o:p></o:p></p> <p class="MsoNormal"><a href="http://www.aaaplasticsurgery.com/plastic-surgeons/dr-repta.cfm">Dr Remus Repta</a><o:p></o:p></p> <p class="MsoNormal">Phoenix/Scottsdale, AZ<o:p></o:p></p>Unknownnoreply@blogger.com9tag:blogger.com,1999:blog-8140316791707391928.post-88500471893791598332012-01-04T18:31:00.000-08:002012-01-15T12:39:29.500-08:00Facial RejuvenationAlthough I initially started this blog as a source of information for patients considering body contouring surgery I have received a fair number of inquiries regarding facial rejuvenation. Below is (almost) everything you ever wanted to know about facial rejuvenation. I hope you find it helpful.<div><br /></div><div><b><a href="http://www.aaaplasticsurgery.com/plastic-surgery/facial-rejuvenation.cfm">Facial Rejuvenation</a></b></div><div>Aging is a process that involves more than just an increase in loose skin. Here are the three main components of aging.</div><div><br /></div><div><b>1) Atrophy/volume loss</b>: The young face is full. As we age we lose volume. Most of this volume is lost as fat but also in bone and muscle. This is perhaps the biggest component of aging and it is ironically the part of aging that has only begun to be appreciated and properly corrected as part of facial rejuvenation in the last few years. Atrophy is the reason why overweight individuals tend to look younger longer--they have more facial volume.</div><div><b><br /></b></div><div><b>2) Soft-tissue laxity:</b> The tissue between our bone and our skin is our soft-tissue. This consists of muscle and connective tissue. With time, as gravity continues, this soft-tissue moves downward. Tissue that once was located in the lower cheek descends below the jawline and becomes jowls, eyebrows become closer to our upper eyelids, the neck develops laxity, and so on. Individuals who have gained and lost significant weight will have stretched this tissue more and often have increased soft-tissue laxity.</div><div><b><br /></b></div><div><b>3) Skin aging: </b>Our skin is our first line of protection from the environment. Sun exposure, pollution, and the remainder of the environment constantly bombards our skin. In response to this our skin fights back by repairing itself but over the years it accumulates the signs of aging. Fine lines, pigment changes, laxity, large pores all develop in response to environmental damage. The top layer of our skin (epidermis) get thicker, and the bottom layer of our skin (dermis) gets thinner. With time, the near constant movement of our facial muscles also results in wrinkles. These wrinkles such as those found between the eyebrows, in the forehead, and on the sides of our eyes are called dynamic wrinkles since they are largely the result of the movement of our facial muscles. </div><div><br /></div><div><br /></div><div><b>So how do we reverse facial aging?</b></div><div><b><br /></b></div><div>There are a vast number of different ways that we can achieve a more youthful appearence. The best way to understand all of these treatments is to group them according to each of three aging factors listed above. In addition, each treatment can be identified as short term or long term, indicating the length that the results are expected to last. Over the last 10-15 years there has been an increasing emphasis on minimally invasive, low downtime, repeatable treatments. Although these type of treatments may be desirable for some patients, the longer lasting, more definitive treatments remain the gold standard and are in fact enjoying a resurgence in popularity.</div><div><br /></div><div><b>1) Atrophy/volume loss: </b></div><div><b>Short term treatment:</b> Fillers are the short term treatment for facial volume loss. Fillers are products that are created by companies that are injected into the face to increase volume. There are many types of fillers including and all of them have positives and negatives. The basic idea of any filler is that it is designed to be repeated anywhere from 6-24 months. They are not permanent. Visit the spa section of our website for a list of available <a href="http://http//www.aaaplasticsurgery.com/medical-spa/fillers.cfm">fillers </a>.</div><div><b>Long term treatment:</b> There are really only two long term (10+ years) or permanent treatment options for facial volume rejuvenation and those are facial implants and <a href="http://http//www.aaaplasticsurgery.com/plastic-surgery/fat-grafting.cfm">fat grafting</a>. Facial implants are really designed to improve the prominence of our facial skeleton. The most common type of implants are chin and cheek, but a whole variety of facial implant are available. These implants are solid and are designed to last a lifetime, although some patients choose to revise the size and shape of these implants as they age and their facial shape changes. Fat grafting involves placing small droplets of fat in areas where fat has diminished. It is obtained from areas of our bodies that we have excess fat and placed carefully and patiently in the areas of our face that would benefit from additional soft tissue volume including the cheeks, jaw line, lips, lower and upper eyelids, temples, earlobes, and occasionally even the nose. The fat that manages to establish blood supply will last forever, although additional volume loss is likely with continued aging.</div><div><br /></div><div><b>2) Soft-tissue laxity:</b></div><div><b>Short term treatment:</b> Most of the treatment options available for the short-term treatment of soft-tissue laxity involve trans-cutaneous delivery of energy. Currently the best technology for this is the <a href="http://http//www.aaaplasticsurgery.com/medical-spa/skin-tightening.cfm">Ulthera </a>system where ultrasound is used to deliver heat to the deep tissue below the skin. The results are not as powerful as surgery and are really only designed to last about a year. </div><div><b>Long term treatment:</b> Long term treatment of soft-tissue laxity is largely confined to surgical procedures such as <a href="http://http//www.aaaplasticsurgery.com/plastic-surgery/face-lift.cfm">face lift, neck lift, eye lid lift, and brow lift among others.</a> These treatments involve surgery to gain access to the deep facial tissues where they are properly positioned. The recovery time and cost of the long term procedures are higher than the short term procedures as expected, but the results are longer lasting, more encompassing, and usually considered as the gold standard.</div><div><br /></div><div><b>3) Skin Aging:</b></div><div><b>Short term treatment:</b> There are many short term treatments for skin rejuvenation. In fact many of these constitute the "medical spa" type treatments that have become so well known. Among these include <a href="http://http//www.aaaplasticsurgery.com/medical-spa/botox.cfm">Botox </a>to relax skin wrinkles caused by facial muscle movement, light <a href="http://http//www.aaaplasticsurgery.com/medical-spa/laser-skin-rejuvenation.cfm">chemical peels, laser, and microdermabrasion</a> for light skin resurfacing, <a href="http://http//www.aaaplasticsurgery.com/medical-spa/photo-facial.cfm">IPL </a>for skin color pigmentation, and a variety of skin care products to improve the texture and appearance of the skin. All of these treatments, especially when done in a medical spa environment, are designed to lightly improved skin aging. They are low to medium down time treatments that often have to be repeated once or twice to get maximum results. The longevity of the result often depends on how the skin is cared for.</div><div><b>Long term treatment: </b>Most of the long term treatments for skin aging are just more aggressive versions of the short term treatments for this category. The deeper the skin is resurfaced via laser or chemical peel the better the result and the longer the results are likely to last given the same skin care. The downside is that these treatments usually require some form of sedation, additional cost, and longer recovery times.</div><div><br /></div><div><br /></div><div>Although facial aging and facial rejuvenation can be a complex and sometime daunting category of information it can be simplified by organizing the information as we have done above. Treatment of aging should also be considered in similar categories including short term and long term treatments as the cost, down time, quality of the results, and longevity of the results will be different.</div><div><br /></div><div><br /></div><div>Below is a quick two question survey regarding preference for short term vs long term facial rejuvenation treatments. Thanks.</div><div><br /></div><div><div align="center"> <object width="300" height="400" wmode="transparent" data="http://apps.quibblo.com/static/flash/qwidget/qwidget.swf?s=&theme=quibblo&quiz=g1Rlp4V" allownetworking="all" allowscriptaccess="never" type="application/x-shockwave-flash"> <param name="movie" value="http://apps.quibblo.com/static/flash/qwidget/qwidget.swf?s=&theme=quibblo&quiz=g1Rlp4V"> <param name="allowscriptaccess" value="never"> <param name="allownetworking" value="all"> <param name="wmode" value="transparent"> <param name="bgcolor" value="ffffff"> </object><br /><span> <a href="http://www.quibblo.com/">Quizzes</a> by <a href="http://www.blogger.com/post-edit.g?blogID=8140316791707391928&postID=8850047189379159833">Quibblo.com</a> | <a href="http://www.snapapp.com/">SnapApp Quiz Apps</a></span> <img src="http://pxl.pmsrvr.com/posting_stats?d=www.quibblo.com&m=widget&c=6b0dbf1ccf6bb3c3333a6be15ff5c9ba5fdaed72&q=g1Rlp4V" alt="" width="1" height="1" style="position:absolute;top:-3000px;left:-3000px;" /> </div></div><div><br /></div><div>All the best,</div><div><br /></div><div><a href="http://http//www.aaaplasticsurgery.com/plastic-surgeons/dr-repta.cfm">Dr Remus Repta</a></div><div>Phoenix/Scottsdale, AZ</div><div><br /></div><div><br /></div><div><b><br /></b></div>Unknownnoreply@blogger.com2tag:blogger.com,1999:blog-8140316791707391928.post-47628006734413967412011-08-03T21:33:00.000-07:002012-01-15T12:37:44.638-08:00Arm rejuvenation<p class="MsoNormal">Younger, tighter, arms.<o:p></o:p></p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">A common complaint of many women with regards to the aging process is the shape and appearance of their upper arms.<span> </span>Despite diet, exercise, and moderation of sun exposure, the upper arms—the area between the elbow and the arm pit—can lose its elasticity and shape.<span> </span>Many women report that the youthful contour of their arms is difficult to maintain through diet and exercise.<span> </span>Patient report a looseness and laxity of the arms that can be seen and felt spanning from the arm pit to the elbow.<span> </span>The severity of the problem varies from one individual to another and can be best understood as four different categories:<o:p></o:p></p> <p class="MsoNormal"><b>Category 1:</b><span> </span>In the first category, the unwanted shape of the upper arm is primarily a result of excess fat.<span> </span>The quality and tone of the skin is relatively good.<span> </span>These individuals respond well to volume loss either by additional diet and exercise or through liposuction or non-invasive fat reduction technologies.<span> </span>More information on this last part with the next blog entry on non-invasive fat and soft tissue treatment technology.<o:p></o:p></p> <p class="MsoNormal"><b>Category 2:</b><span> </span>Skin and soft tissue laxity is present, but it is primarily located in the upper part of the upper arm near the axilla (arm pit).<span> </span>These patients are best suited either by an axillary tuck, also known as a short incision arm lift, or by a series of non-invasive treatments designed to tighten the deeper tissue of the arm.<span> </span>An example of this type of non-invasive therapy is Ulthera.<span> </span>Which modality would be best is determined by the extent of the laxity as well as the goal of the patient.<o:p></o:p></p> <p class="MsoNormal"><b>Category 3:</b><span> </span>Skin and soft tissue laxity is present throughout the entire length of the upper arm.<span> </span>These individuals are often best treated by a full arm lift requiring an incision the length of the upper arm.<span> </span>If laxity is only moderate or if some degree of residual deformity can be tolerated a short incision arm lift with the future addition of a non-invasive soft tissue tightening technology may also be reasonable.<span> </span>In my experience, however, category 3 patients are often best treated by a full incision long enough to accomplish a more definitive result as opposed to utilizing a smaller incision and leaving residual upper arm laxity.<o:p></o:p></p> <p class="MsoNormal"><b>Category 4:</b><span> </span>Skin laxity is present primarily just above the elbows.<span> </span>These patients have traditionally been the most difficult to treat as the options have been limited.<span> </span>An incision at or just above the elbow is visible and is prone to healing poorly due to the mechanical action of the elbow joint.<span> </span>Recently treatment with non-invasive soft tissue tightening technologies has provided a very good option for those with mild to moderate elbow skin laxity with the only downside being that the procedure would have to be repeated yearly.</p><p class="MsoNormal"><span>All the best,</span></p><p class="MsoNormal"><span><a href="http://www.aaaplasticsurgery.com/plastic-surgeons/dr-repta.cfm">Dr. Remus Repta</a></span></p><p class="MsoNormal"><span>Phoenix/Scottsdale Plastic Surgery</span></p>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8140316791707391928.post-76743699844099151532011-07-20T07:23:00.000-07:002012-01-15T12:36:53.955-08:00Laxity: what is it, what causes it, and how do we fix it.<span class="Apple-style-span" style="border-collapse: collapse; font-family: arial, sans-serif; font-size: 13px; "><br /><br />Aging is a complex process that is a result of environmental experiences as well as genetics. Its effects are seen in our both, face, mind, and spirit. Although some aging effects are positive--wisdom, patience, experience-- most of the physical signs are undesirable. Among the undesirable effects of aging, laxity is the most easily recognized and often unwanted.<br /><br />Laxity related to aging can be seen in any area of the body. The face, neck, arms, breasts, abdomen, hips, and thighs are frequent areas of undesirable excess soft tissue laxity related to aging. Soft tissue laxity related to aging occurs secondary to underlying volume loss, loss of elasticity of the skin, and stitching of the underlying ligaments that attach the skin to the underlying muscles and structure. This process is largely genetic but can be significantly impacted by a handful of environmental experiences including but not limited to sun exposure, smoking, poor nutrktion, certain chronic medical conditions, and weight gain/ weight fluctuation. The rate of development of soft tissue laxity as well as the extent of the excess laxity that develops is a complex interaction of genetic and environmental factors listed above. Minimizing development of soft tissue laxity is an important part of aging gracefully. Notice that we have not said "prevention" of laxity, since currently preventing aging is still a futuristic idea.<br /><br />So how do we go about minimizing development of soft tissue laxity. Well, since we currently cannot control our genetics we must focus all of our attention on the environment. Treating our body well by giving it the proper rest, dehydration, and nutrition is a good start. Avoiding smoking, excessive sun exposure, and the development of certain chronic illnesses is next on the list. Lastly, there are a number of technologies on the market that may help to slow down some of the laxity that would normally develop. These technologies revolve around the idea of imparting energy, usually transcutaneously (through the skin), to help slow down the stretching of the ligaments that attach the skin to the underlying structures and to help build collage which would help in the rate of elasticity loss of the skin. There are many brands of machines that work on this principle. Some work better than others and none offer a magic bullit. Skin care products that are applied to the skin as lotions and claim to have the same affect are many but how well they work if at all is even more in question.<br /><br />So, we can't completely prevent laxity from developing, then how do we treat it when laxity becomes too much. Treatment of soft tissue laxity should be generally thought of in two categories: non-surgical and surgical. The list of effective non-surgical treatments for soft tissue laxity is short. In my personal opinion, Ulthera is probably the only non surgical soft tissue laxity treatment that has reasonable effectiveness. There are a handful of treatments for the face that result in less facial laxity but these work primarily on the skin to "shrink wrap" it and not on the underlying soft tissue. These include the larger category of deep chemical and laser skin resurfacing procedures.</span><div><span class="Apple-style-span" style="border-collapse: collapse; font-family: arial, sans-serif; font-size: 13px; "><br /></span></div><div><span class="Apple-style-span" style="border-collapse: collapse; font-family: arial, sans-serif; font-size: 13px; ">Finally, there are the surgical solutions to excessive laxity. A brief list of surgical solutions to excess laxity is shown below and can be found more in depth in earlier blog entries.</span></div><div><span class="Apple-style-span" style="border-collapse: collapse; font-family: arial, sans-serif; font-size: 13px; "><br /></span></div><div><span class="Apple-style-span" style="border-collapse: collapse; font-family: arial, sans-serif; font-size: 13px; "><p class="MsoNormal"><b style="mso-bidi-font-weight:normal">Full body lift:</b><span style="mso-spacerun:yes"> </span>The body lift is the cornerstone procedure in the rejuvenation process following significant weight loss.<span style="mso-spacerun:yes"> </span>It allows complete correction of the abdomen, the hips, the buttocks, as well as the back and sides of the thighs.<span style="mso-spacerun:yes"> </span>The body lift procedure also results in lifting and tightening of the mons pubis.<span style="mso-spacerun:yes"> </span>The final incision line is near the mons in front and follows the bikini line around the waist running at the natural border of the upper buttocks and lower back.<span style="mso-spacerun:yes"> </span>It can be combined with liposuction or with a procedure known as <i style="mso-bidi-font-style:normal">purse-string gluteoplasty</i> that is designed to use your own tissue that would have been removed to add volume to the buttocks.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal">Brachioplasty:</b><span style="mso-spacerun:yes"> </span>There are a handful of different options designed to improve the appearance of the arms following weight loss.<span style="mso-spacerun:yes"> </span>The procedure of choice depends on the amount of skin and soft-tissue laxity present and the amount of improvement desired.<span style="mso-spacerun:yes"> </span>The final incision can be in the arm pit or in the middle part of the inner arm surface.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal">Breast augmentation and lift:<span style="mso-spacerun:yes"> </span></b>Most patients who have experiences significant weight loss require a breast lift to improve the shape and position of their breasts.<span style="mso-spacerun:yes"> </span>A breast lift or mastopexy can be combined with an augmentation to restore the breast volume.<span style="mso-spacerun:yes"> </span>Breast augmentation can be accomplished by using an implant or by using the excess skin and soft-tissue that would have been removed by the breast lift procedure.<span style="mso-spacerun:yes"> </span>During your consultation Dr. Repta can discuss which combination of procedures will best give you the result that you are looking for. </p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal">Bra Line Back Lift:</b><span style="mso-spacerun:yes"> </span>Dr. Repta’s Bra Line Back Lift procedure is designed to eliminate the folds and rolls that accumulate in the upper and middle back near the bra line as a result of excess skin and soft-tissue laxity.<span style="mso-spacerun:yes"> </span>Liposuction alone will not correct these areas since in addition to some excess fat there is often a significant amount of excess laxity.<span style="mso-spacerun:yes"> </span>The final incision line of the Bra Line Back Lift is placed in the horizontal part of the brassiere strap.<span style="mso-spacerun:yes"> </span>Recovery is relatively easy and straightforward and patients who have been good candidates for the Bra Line Back Lift procedure have been uniformly ecstatic about their results.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal">Thigh Lift:</b><span style="mso-spacerun:yes"> </span>In addition to the full body lift which helps improve the laxity of the sides and back of the thighs, there are two specific thigh lift procedures designed to improve the appearance of the thighs.<span style="mso-spacerun:yes"> </span>These include the crescent thigh lift and the vertical thigh lift.<span style="mso-spacerun:yes"> </span>The crescent thigh lift is designed for patients who have laxity primarily in the upper inner thighs while the vertical thigh lift is designed for patients who have substantially more laxity the entire length of the inner and outer thighs.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal">Face and Neck Rejuvenation: </b><span style="mso-spacerun:yes"> </span>Many patients who have experienced significant weight loss desire facial rejuvenation to correct the substantial amount of skin and soft-tissue laxity of the face and neck.<span style="mso-spacerun:yes"> </span>A variety of facial rejuvenation procedures are available to help you achieve your goal.<span style="mso-spacerun:yes"> </span>Although weight loss has been the primary goal, the face often needs a healthy amount of volume to maintain its youthful shape and contour.<span style="mso-spacerun:yes"> </span>Fat grafting for volume replenishment of the face is an integral component of facial rejuvenation following significant weigh loss.</p><p class="MsoNormal">All the best,</p><p class="MsoNormal"><a href="http://www.aaaplasticsurgery.com/plastic-surgeons/dr-repta.cfm">Dr. Remus Repta</a></p><p class="MsoNormal">Phoenix/Scottdale, AZ</p><p class="MsoNormal"><br /></p></span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8140316791707391928.post-8040133316535951942011-05-14T17:26:00.000-07:002012-01-15T12:36:06.019-08:00Better looking thighs.<p class="MsoNormal">One of the most common body contouring requests involves the thighs.<span style="mso-spacerun:yes"> </span>Women, and sometimes men, of all ages have variable complaints about the appearance of their thighs.<span style="mso-spacerun:yes"> </span>Problem areas may be the inner thighs, the outer thighs, front part of the thighs, and of course the back part of the thighs.<span style="mso-spacerun:yes"> </span>Although patients often complain more about one section of the thighs as listed above it is the entire upper leg or thigh area that needs improvement.<span style="mso-spacerun:yes"> </span>The problem or issue that requires improvement usually falls into one or both of the following categories:</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal" style="margin-left:.5in;text-indent:-.25in;mso-list:l0 level1 lfo1; tab-stops:list .5in"><!--[if !supportLists]--><span style="mso-list:Ignore">1)<span style="font:7.0pt "Times New Roman""> </span></span><!--[endif]-->Excess fat</p> <p class="MsoNormal" style="margin-left:.5in;text-indent:-.25in;mso-list:l0 level1 lfo1; tab-stops:list .5in"><!--[if !supportLists]--><span style="mso-list:Ignore">2)<span style="font:7.0pt "Times New Roman""> </span></span><!--[endif]-->Excess laxity</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal">Excess fat<o:p></o:p></b></p> <p class="MsoNormal">Excess fat in the thighs can present as an overall size issue “my thighs are too big” or as a shape issue “I hate the bulge of fat on the outer thighs, or my inner thighs touch”.<span style="mso-spacerun:yes"> </span>Excess fat is one of the easier problems to fix.<span style="mso-spacerun:yes"> </span>There are various forms of fat removal available including that fall into various categories including non-invasive, invasive, immediate improvement, delayed improvement, etc.<span style="mso-spacerun:yes"> </span>Most patients who have appreciable amounts of excess fat and want the best possible result will be good candidates for the more direct and definitive fat removal technologies involving liposuction such as power assisted liposuction, ultrasound assisted liposuction, traditional liposuction, etc.<span style="mso-spacerun:yes"> </span>Patients who simply have excess fat without excess laxity and good skin will be served well by reduction of this excess fat through such liposuction technologies.<span style="mso-spacerun:yes"> </span>These can be performed under local or general anesthesia and usually involve one or more small, 2-3 mm, access incisions.<span style="mso-spacerun:yes"> </span>Patients who have only an excess fat issue tend to be between 20-40 years old and usually have not had significant fluctuations in their weight.</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal">Excess laxity</b></p> <p class="MsoNormal">Excess soft-tissue laxity of the thighs is a very frequent complaint from patients.<span style="mso-spacerun:yes"> </span>Excess laxity is usually seen in the slightly older patient population, perhaps 30-onward, but can also be seen in patients who have had significant weight fluctuation or weight loss.<span style="mso-spacerun:yes"> </span>To date, there does not exist any technology that can significantly reduce, on a long term time frame, excess soft-tissue laxity via a non-invasive modality.<span style="mso-spacerun:yes"> </span>To put it another way, significant improvement in soft-tissue laxity requires an direct removal of the excess tissue laxity and therefore requires an incision and by definition some form of scar.<span style="mso-spacerun:yes"> </span>Excess laxity of the thighs can be treated by various forms of lifts as described below:</p> <p class="MsoNormal"><span style="mso-tab-count:1"> </span></p> <p class="MsoNormal" style="margin-left:.5in;text-indent:-.25in;mso-list:l1 level1 lfo2; tab-stops:list .5in"><!--[if !supportLists]--><span style="mso-list:Ignore">1)<span style="font:7.0pt "Times New Roman""> </span></span><!--[endif]-->Back of the thigh:<span style="mso-spacerun:yes"> </span>the back of the thighs or “posterior” thighs can be lifted and tightened by performing a buttock lift.<span style="mso-spacerun:yes"> </span>By repositioning and tightening the buttock the posterior thigh is also lifted and tightened.<span style="mso-spacerun:yes"> </span>The final incision is in the bikini line at the junction between the buttock and lower back.<span style="mso-spacerun:yes"> </span>This incision can be well hidden and heals very well if performed properly.<span style="mso-spacerun:yes"> </span>This procedure usually creates substantial improvement in the shape, position, and contour of both the buttock and thighs.<span style="mso-spacerun:yes"> </span>It can also be combined with liposuction and fat grafting of the buttock to achieve maximum improvement in the appearance of the buttocks area.</p> <p class="MsoNormal" style="margin-left:.5in;text-indent:-.25in;mso-list:l1 level1 lfo2; tab-stops:list .5in"><!--[if !supportLists]--><span style="mso-list:Ignore">2)<span style="font:7.0pt "Times New Roman""> </span></span><!--[endif]-->Inner thigh:<span style="mso-spacerun:yes"> </span>The inner thighs can be treated for excess laxity in one of two ways.<span style="mso-spacerun:yes"> </span>Significant laxity the whole length of the inner thigh also involving components of the anterior and lateral thighs is best treated with a length-wise or vertical thigh lift.<span style="mso-spacerun:yes"> </span>This requires removal of excess soft tissue laxity the entire length of the inner thigh and results in a subsequent vertical inner thigh incision that is as long as needed to maximize the results.<span style="mso-spacerun:yes"> </span>This can potentially span the entire length of the inner thigh from groin to the knee area.<span style="mso-spacerun:yes"> </span>Although the scar is long, the reduction of laxity is significant and the results are usually the longest lasting.<span style="mso-spacerun:yes"> </span>Massive weight loss patients are usually good candidates for this procedure.<span style="mso-spacerun:yes"> </span>Patients with small amounts of laxity, particularly near the groin area, can be treated with a crescent inner thigh lift where the final incision is located at the crease between the thigh and groin area.<span style="mso-spacerun:yes"> </span>This procedure has a more concealable scar but its ability to remove tissue laxity is much less than the vertical thigh lift procedure.<span style="mso-spacerun:yes"> </span>Care needs to be taken to not place undue tension on the closure as lowering of the scar can bee seen and spreading of the outer labia can occur.</p> <p class="MsoNormal" style="margin-left:.5in;text-indent:-.25in;mso-list:l1 level1 lfo2; tab-stops:list .5in"><!--[if !supportLists]--><span style="mso-list:Ignore">3)<span style="font:7.0pt "Times New Roman""> </span></span><!--[endif]-->Body lift:<span style="mso-spacerun:yes"> </span>The body lift procedure involves a tummy tuck, lateral (side) thigh lift, and buttock lift.<span style="mso-spacerun:yes"> </span>It is designed to place the final incision in the bikini line and provide global improvement of the soft-tissue laxity of the outer thighs, posterior thighs via the buttock lift, and a portion of the front of the thighs.<span style="mso-spacerun:yes"> </span>The inner thighs may require additional treatment for maximum correction as indicated in #2 above.<span style="mso-spacerun:yes"> </span>This can be done at the same time or as a separate surgical proceure.</p><p class="MsoNormal" style="margin-left:.5in;text-indent:-.25in;mso-list:l1 level1 lfo2; tab-stops:list .5in"><br /></p><p class="MsoNormal" style="margin-left:.5in;text-indent:-.25in;mso-list:l1 level1 lfo2; tab-stops:list .5in">All the best,</p><p class="MsoNormal" style="margin-left:.5in;text-indent:-.25in;mso-list:l1 level1 lfo2; tab-stops:list .5in"><span style="text-indent: -0.25in; "><a href="http://www.aaaplasticsurgery.com/plastic-surgeons/dr-repta.cfm">Dr. Remus Repta</a></span></p><p class="MsoNormal" style="margin-left:.5in;text-indent:-.25in;mso-list:l1 level1 lfo2; tab-stops:list .5in">Phoenix/Scottsdale </p>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-8140316791707391928.post-79905885253349075582011-04-26T21:09:00.000-07:002012-01-15T12:34:51.424-08:00Decisions in breast lift surgery. Incisions, scars, and breast shape.<span class="Apple-style-span" style="border-collapse: collapse; font-family: arial, sans-serif; font-size: 13px; "><div><br /></div><div>A frequent discussion that takes place with regards to breast shaping and breast lift surgery is scars. It is no surprise that the desire to minimize and prevent scars on the breast is an important discussion point. The breasts, aside from breast feeding, are an extremely sensual part of the female body. For women who have lost their natural breast shape and have developed laxity and drooping a breast shaping procedure such as a breast lift is usually required to restore the position of the breast tissue, shape and size of the areola, and firmness or skin tension to its natural and most aesthetic level.</div><div> </div><div>My discussion, whenever skin is in excess or there is excess skin and soft tissue laxity, inevitably revolves around the idea that fat and mucsle can be changed through diet and excercise but significant excess skin must be removed surgically. Removal of excess skin by definition involves making an incision. For breast lift surgery, an incision is needed to make the areola smaller, to elevate the areola to a higher position, and to remove the excess skin and contour the breast and breast tissue.</div><div> </div><div>The inevitable questions then becomes, do we accept the needed incisions and subsequent scars in exchange for better breast shape? The simple answer is that the overall shape is always more important than an extra incision. The more detailed discussion goes as follows. An incision that heals well and is in the end a paper thin scar should be accepted in exchange for a significantly improved shape. I have never had one patient that has regretted getting a breast lift. They see the improved breast shape and position and the presence of paper thin scars becomes a very easy tradeoff to make. Remember, we make incisions on the face for facial rejuvenation including incisions on the eyelids and nose for eyelid and nose shaping. It seems that a well healed and positioned incision that delivers the best result possible in terms of breast shape and position should be judged in the same way.</div><div> </div><div>When it comes to incisions and scars two things must be understood. If they are done properly the final scar should be paperthin and nearly invisible when full healing has occured. The second is that a perfectly shaped breast with a thin, nearly invisble incision is much more aesthetic and desireable then a droopy breast with a large areola and no scars. In the end, its the patient who has to decide what they value most. For my family, friends, and loved ones I would certainly steer them toward better shape.</div><div> </div><div><br /></div><div>All the best,</div><div> </div><div><a href="http://www.aaaplasticsurgery.com/plastic-surgeons/dr-repta.cfm">Dr. Remus Repta</a></div><div>Board Certified Plastic Surgeon</div><div>Phoenix/Scottsdale AZ</div></span>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-8140316791707391928.post-56338019667217905922011-03-28T16:38:00.000-07:002012-01-15T12:34:14.438-08:00Capsule contracture<b>What is capsule contracture?</b><div><b><br /></b></div><div>Capsule contracture or capsule formation is a condition where excessive internal scar tissue develops. Although it is most commonly discussed in reference to breast augmentation using an implant it can occur in a variety of situations. The body naturally develops a layer of scar surrounding any object that inside the body that is deemed foreign or otherwise not usually present. This can include a variety of implants such as breast implants, facial implants, calf implants, as well as pace makers and other medical devices including joint replacement implants, etc. The thin layer of scar tissue that naturally develops over these implants is deemed normal and in fact beneficial since the implant is separated from the surrounding tissue by this thin layer of scar tissue. Capsule contracture or capsule formation are some of the terms used to describe an abnormally thick capsule formation. Capsule contracture can be detected and diagnosed by excess fullness, excess firmness, or distortion of the surrounding area. When capsule contracture occurs in relation to breast augmentation the breast can become firm and painful and the shape of the breast becomes distorted by the abnormally thick capsule scar.</div><div><br /></div><div><b>Why does capsule contacture occur?</b> </div><div>This is a question that is sometime debated amongst specialists. My philosophy is as follows. If a thin layer of capsule formation is normal then a capsule contracture occurs when the body simply continues the process for an extended period of time. That is, the body forms a thin layer of capsule through the healing process which is a result of the natural inflammatory phase of healing. A capsule contrature is simply the body saying that there is an excess or prolonged inflammatory phase and it needs to build a thick capsule. An excess or prolonged inflammatory phase can occur in a variety of circumstances and includes: infection, bleeding, and seroma or excessive healing fluid.</div><div><br /></div><div><b>How is capsule contracture prevented? </b></div><div>With regards to breast augmentation, the incidence of capsule contrature can be minimized by having minimal or no bleeding during the procedure and by placing the implant through a minimal touch technique where the implant touching the surrounding skin is minimized. Beyond this, additional ways to minimize the occurrence of capsule contracture may include massage of the breast, post operative antibiotics, the use of certain medications such as singulair, the use of post operative drains, etc. This second group of measures are debatable in terms of reducing the incidence of capsule contracture.</div><div><br /></div><div><b>How is capsule contracture corrected once it forms?</b> </div><div>Once capsule contracture occurs the incidence for recurrence of capsule contracture is increased for subsequent breast augmentation revisions. Because of this I favor the philosophy of treating the problem aggressively. To accomplish this my treatment plan for breast capsule contracture involves:</div><div>1) Removal of all breast capsule (full capsulectomy)</div><div>2) Replacement of the implant with a new implant (implant exchange)</div><div>3) Placement of the new implant in a newly formed pocket (neo pocket creation)</div><div>4) +/- use of a drain, massage, singulair, etc.</div><div><br /></div><div><br /></div><div><br /></div><div>Another interesting discussion point to consider is the formation of a capsule contracture following a tummy tuck. This is often referred to as a pseudobursa and often occurs as a result of persistent presence of healing fluid or seroma. Just as in breast augmentation capsule contracture, pseudobursa following a tummy tuck is simply the creation of excessive scar tissue. This can occur following a tummy tuck when the body detects an elevated or persistent inflammatory phase. The body forms a thick scar tissue or pseudobursa in response to this inflammatory phase. It can be detected by excessive fullness usually just above the central part of the lower incision or just above the belly button. Prevention and treatment of a tummy tuck pseudobursa occurs in much the same way as prevention and treatment of a breast augmentation capsule contracture.</div><div><br /></div><div>Sincerely,</div><div><br /></div><div><a href="http://www.aaaplasticsurgery.com/plastic-surgeons/dr-repta.cfm">Dr. Remus Repta</a></div><div>Phoenix Scottsdale plastic surgery </div><div><br /><div><br /></div><div><br /></div></div>Unknownnoreply@blogger.com3tag:blogger.com,1999:blog-8140316791707391928.post-75037618949402453012011-01-20T09:40:00.000-08:002012-01-15T12:33:07.638-08:00Gynecomastia---Getting the weight off your chest.<b>What is gynecomastia?</b><div><b><br /></b></div><div>The simplest way to define gynecomastia is: fullness of the chest area in males often centering around the areola. It can be caused by a number of different reasons, it can be present since early childhood or arise in adulthood, and it can be very small or significant in the extent of size.</div><div><br /></div><div>The patients that I have seen and treated for gynecomastia could generally be categorized into three different groups shown below. The ideal treatment is based on the category of gynecomastia. Of course if there is a source to the gynecomastia such as hormone issues, or steroid use, etc these should be stopped or corrected.</div><div><br /></div><div>Group 1: Patients who are otherwise overweight and have developed gynecomastia secondary to excessive fat deposits in the chest area are best treated with liposuction. The majority of the tissue that concerns these patients is fat and can be easily and efficiently removed with liposuction through small, 3 mm, micro-incisions.</div><div><br /></div><div>Group 2: Some patients note that they have always had a little extra fullness around the areola. They are relatively thin and the tissue that bothers them is a little firmer but still largely soft. That is, there is some glandular tissue there but not overtly fibrous or firm. These patients can also be treated with liposuction especially if the tissue in question has an indistinct border and is relatively soft. Conversely, excision of the tissue through a small incision at the border of the areola and skin can also be performed. This is a good option if the tissue is smaller in size with relatively more distinct borders.</div><div><br /></div><div>Group 3: These patients are usually body builders or have a history of steroid use. The chest tissue is usually very firm and very distinct from the surrounding normal tissue. Liposuction is not an ideal procedure as it rarely is able to remove enough of the tough fibrous tissue necessary to achieve the ideal results desired. These patients are often ideally treated with direct excision through a small incision at the border of the areola and normal skin.</div><div><br /></div><div>In terms of anesthesia, both local anesthesia or IV sedation/general anesthesia can be performed based on patient preference and body characteristics.</div><div><br /></div><div>The take-home point is that gynecomastia is much more common than most people realize and that easy solutions and satisfying results can be obtained.</div><div><br /></div><div>All the best,</div><div><br /></div><div><a href="http://www.aaaplasticsurgery.com/plastic-surgeons/dr-repta.cfm">Dr. Remus Repta</a></div><div>Phoenix/Scottsdale, AZ </div>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-8140316791707391928.post-30884821057277822692010-05-12T10:58:00.000-07:002012-01-15T12:30:05.647-08:00Dont Sweat It<span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:medium;"><div><span class="Apple-style-span" style="font-size:medium;"><br /></span></div><div><span class="Apple-style-span" style="font-size:medium;">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. </span></div><div><span class="Apple-style-span" style="font-size:medium;"><br /></span></div><span class="Apple-style-span" style="font-size:medium;">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.</span></span></span><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style=" border-collapse: collapse; font-family:arial, sans-serif;font-size:13px;"><div><b><span class="Apple-style-span" style="font-weight: normal;"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:medium;">The procedure is called SASS underarm </span><span class="Apple-style-span" style="font-size:x-small;">TM</span><span class="Apple-style-span" style="font-size:medium;"> (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.</span></span></span></b></div><div><b><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></b></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:medium;">All the best,</span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:medium;"><br /></span></span></div><div><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:medium;"><a href="http://www.aaaplasticsurgery.com/plastic-surgeons/dr-repta.cfm">Dr. Remus Repta</a></span></span></div><div><b><span class="Apple-style-span" style="font-weight: normal;"><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:medium;"></span></span></span><span class="Apple-style-span" style="font-family:'times new roman';"><span class="Apple-style-span" style="font-size:medium;"> </span></span></b></div></span></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8140316791707391928.post-50056756925388969622010-04-11T10:15:00.000-07:002012-01-15T12:28:45.488-08:00Tummy Tuck ScarsA 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:<div><br /></div><div><b>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?</b></div><div><b><br /></b></div><div>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.</div><div><br /></div><div><b>How will my Tummy Tuck Scars look and feel when I am nude?</b></div><div><b><br /></b></div><div>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. </div><div><br /></div><div>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.</div><div><br /></div><div><b>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?</b></div><div><b><br /></b></div><div>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.</div><div><br /></div><div>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 <b>tummy tuck repair</b>. </div><div><br /></div><div>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.</div><div><br /></div><div>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.</div><div><br /></div><div><br /></div><div>All the best,</div><div><br /></div><div><a href="http://www.aaaplasticsurgery.com/plastic-surgeons/dr-repta.cfm">Dr. Remus Repta</a></div>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-8140316791707391928.post-51818444302767415872010-02-04T07:53:00.000-08:002012-01-15T12:23:24.442-08:00Tummy Tuck Repair<b>What is Tummy Tuck Revision?</b><div><b><br /></b></div><div>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:</div><div><p class="MsoNormal"><o:p> <b><span class="Apple-style-span" style="font-size: medium;">List of potential tummy tuck issues:</span></b></o:p></p> <p class="MsoNormal"><b><span class="Apple-style-span" style="font-size: medium;">Poor scars</span></b><span class="Apple-style-span" style="font-size: medium;">: 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.</span></p> <p class="MsoNormal"><o:p><b><span class="Apple-style-span" style="font-size:medium;">Belly button/umbilicus</span></b><span class="Apple-style-span" style="font-size:medium;">: 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.</span></o:p></p> <p class="MsoNormal"><o:p><b><span class="Apple-style-span" style="font-size:medium;">Excess fat</span></b><span class="Apple-style-span" style="font-size:medium;">: 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.</span></o:p></p> <p class="MsoNormal"><o:p><b><span class="Apple-style-span" style="font-size:medium;">Excess skin laxity</span></b><span class="Apple-style-span" style="font-size:medium;">: 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.</span></o:p></p> <p class="MsoNormal"><o:p><b><span class="Apple-style-span" style="font-size:medium;">“Dog-ears”</span></b><span class="Apple-style-span" style="font-size:medium;">: 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.</span></o:p></p> <p class="MsoNormal"><o:p><b><span class="Apple-style-span" style="font-size:medium;">Uneven surface</span></b><span class="Apple-style-span" style="font-size:medium;">: 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.</span></o:p></p> <p class="MsoNormal"><o:p><b><span class="Apple-style-span" style="font-size:medium;">Pseudobursa</span></b><span class="Apple-style-span" style="font-size:medium;">: </span><span style="color:black;"><span class="Apple-style-span" style="font-size:medium;">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.</span></span></o:p></p> <p class="MsoNormal"><o:p><span class="Apple-style-span" style="font-size:medium;"> </span></o:p></p><p class="MsoNormal"><o:p><span class="Apple-style-span" style="font-size:small;">All the best,</span></o:p></p><p class="MsoNormal"><o:p><span class="Apple-style-span" style="font-size:small;"><a href="http://www.aaaplasticsurgery.com/plastic-surgeons/dr-repta.cfm">Dr. Remus Repta</a></span></o:p></p></div>Unknownnoreply@blogger.com19tag:blogger.com,1999:blog-8140316791707391928.post-871977086060749222009-09-01T13:08:00.000-07:002012-01-15T12:21:39.418-08:00Circumferential tummy tuck (Body Lift)<div><b>What is a Body Lift or Circumferential tummy tuck?</b><div><b><br /></b></div><div>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.</div><div><br /></div><div><b>Who is a candidate for a Body Lift?</b></div><div><br /></div><div>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.</div><div><br /></div><div><b>Where are the incisions?</b></div><div>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.</div></div><div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg46jMomxJ3CJeGZbazbNOcRXA3HT7J5Al4D6QeTShip2fzzWKN9GTgHWOX5rO5Aj5cZPpE486pnhoBRm-QoIvmUzJDOaMufFYbec32AhEWz3zjmO2GrfAVyjsbN0CPS5fuy4kCch998eg/s1600-h/bl+after+2.jpg" style="text-decoration: none;" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><br /></a></div><div>All the best,</div><div><br /></div><div><a href="http://www.aaaplasticsurgery.com/plastic-surgeons/dr-repta.cfm">Dr. Remus Repta</a><br /><div style="text-align: center;"><span class="Apple-style-span" style="text-decoration: underline;"><span class="Apple-style-span" style="color:#0000EE;"><br /></span></span></div><div style="text-align: center;"><br /></div></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8140316791707391928.post-31646917308769876342009-08-27T14:59:00.000-07:002012-01-15T12:19:09.252-08:00Lip Augmentation<b>How can lips be made fuller, younger looking?</b><div><br /></div><div>Recently I was interviewed by a local new station regarding the new <b>PermaLip implant</b>. 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.</div><div><br /></div><div>Other options for achieving fuller lips include using <b>hyaluronic acid fillers (juvederm, restylane, etc), injecting fat, or placing various types of material including fascia, skin, and goretex</b>.</div><div><br /></div><div>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.</div><div><br /></div><div>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.</div><div><br /></div><div>All the best,</div><div><br /></div><div><a href="http://www.aaaplasticsurgery.com/plastic-surgeons/dr-repta.cfm">Dr. Remus Repta</a></div>Unknownnoreply@blogger.com3tag:blogger.com,1999:blog-8140316791707391928.post-80707072578061368222009-08-12T14:17:00.000-07:002012-01-15T12:17:43.987-08:00Breast Augmentation<b>Breast Augmentation</b><div><b><br /></b></div><div>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.</div><div><br /></div><div>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.</div><div><br /></div><div><b>Implant types </b></div><div>Saline</div><div><span class="Apple-tab-span" style="white-space:pre"> </span>Smooth shell<br /></div><div><span class="Apple-tab-span" style="white-space:pre"> </span>Textured<br /></div><div>Silicone (gummy bear)</div><div><span class="Apple-tab-span" style="white-space:pre"> </span>Smooth shell<br /></div><div><span class="Apple-tab-span" style="white-space:pre"> </span>Textured shell<br /></div><div>Silicone (form stable)</div><div><span class="Apple-tab-span" style="white-space:pre"> </span>Textured shell only<br /></div><div>Fat</div><div><br /></div><div><b>Incision location</b></div><div>Peri-areolar (at the border of the areola and breast skin)</div><div>Trans-axillary (through the arm pit)</div><div>Inframmamary (at the breast fold/under the breast)</div><div>Trans-umbilical (aka TUBA, through the belly button)</div><div><b><br /></b></div><div><b>Placement</b></div><div>Sub-glandular (under the breast gland)</div><div>Sub-fascial (under the covering on top of the muscle)</div><div>Sub-pectoral (under the muscle)</div><div><br /></div><div><br /></div><div>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 <b>implant type</b>, <b>incision location,</b> and <b>placement</b>. </div><div><br /></div><div><b>Breast implant type</b></div><div>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.</div><div><br /></div><div><b>Incision location</b></div><div>The location of the incision for placement of the breast implant is determined by patient preference but also by implant type and implant size. </div><div><br /></div><div>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. </div><div><br /></div><div>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.</div><div><br /></div><div>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.</div><div><br /></div><div>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.</div><div><br /></div><div><br /></div><div><b>Implant placement</b></div><div><br /></div><div>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. </div><div><br /></div><div>I hope this helps. More to come in the near future about breast augmentation.</div><div><br /></div><div>All the best,</div><div><br /></div><div><a href="http://www.aaaplasticsurgery.com/plastic-surgeons/dr-repta.cfm">Dr. Remus Repta</a></div>Unknownnoreply@blogger.com1tag:blogger.com,1999:blog-8140316791707391928.post-16324389941838948142009-04-26T11:06:00.000-07:002009-09-21T21:39:16.763-07:00Buttock Fat Grafting<span class="Apple-style-span" style="font-weight: bold;">What is buttock fat grafting?</span><div><span class="Apple-style-span" style="font-weight: bold;"><br /></span></div><div>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).<br /><br /></div><div><span class="Apple-style-span" style="font-weight: bold;">When is buttocks fat grafting performed?</span></div><div><br /></div><div>It is performed most commonly for augmentation, or increasing the size of the buttocks, as well as shaping and correcting contour irregularities.</div><div><br /></div><div><span class="Apple-style-span" style="font-weight: bold;">What are the benefits of fat grafting?</span></div><div><br /></div><div>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. </div><div><br /></div><div><span class="Apple-style-span" style="font-weight: bold;">What are the drawbacks of buttocks fat grafting?</span></div><div><br /></div><div>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.</div><div><br /></div><div><span class="Apple-style-span" style="font-weight: bold;">What is the recovery time like?</span></div><div><br /></div><div>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.</div><div><br /></div><div><br /></div><div>Stay tuned for buttocks augmentation using implants as the next blog entry.</div><div><br /></div><div><br /></div><div>All the best,</div><div><br /></div><div>Dr. Repta</div><div>Phoenix/Scottsdale Plastic Surgeon</div><div><br /></div><div><br /></div><div><br /></div>Unknownnoreply@blogger.com1