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January 1, 2030
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Combining a breast lift with a breast augmentation is a transformative life-changing procedure that restores not only beauty but self-confidence. Few other operations in aesthetic surgery can be as powerful as a breast lift with augmentation. Commonly, this is realized after the operation with such appreciative patients.
However, to achieve an optimal outcome (preserving nipple viability, nipple sensation, and restoring youthful co... Continue reading
Culture has placed emphasis on the breasts and buttocks for female beauty and plastic surgery for these two anatomic areas are in demand. Fat transfer to the buttock is the most popular technique to reshape the buttock. It’s a powerful and effective method to enhance buttock shape because the addition of volume is combined with the subtraction of liposuction. In reality, it’s the redistribution of fat that makes it so effective.
A 30-... Continue reading
Perception is reality and our countenance influences perception in our daily interactions. I often hear others being perceived as angry, sad, or tired even though they are not angry, sad, or tired. Commonly, you may hear others say to “smile” or “cheer up”. The tissue around the eyes are critically important for conveying emotion and the eyes are commonly referred to as “Windows to the Soul”. It’s the periorbital tissue (tissue around the eyes) that likely has greater influence in cou... Continue reading
The tummy tuck operation is a very popular body contouring procedure. In 2016, over 127,000 tummy tucks were performed in the USA. Since year 2000 there has been a 104% increase in the procedure.
The operation consists of removing extra skin and adipose (fat) tissue from the lower abdomen and pulling the remaining upper abdominal skin tighter after elevating it from the abdominal wall. Additionally, the abdominal wall muscle and... Continue reading
Diet, exercise, and liposuction are a powerful combination to obtain maximal results in body contouring without large scars. Liposuction is not a “magic pill” for weight loss but when used appropriately it is dynamic adjunct when someone is motivated to change their body shape.
Despite diet and exercise there are persistent areas of the body which no matter the amount of exercise training are difficult to improve without the help of plas... Continue reading
Macromastia is the abnormal enlargement of breast tissue. It’s the consequence of increased end-organ (breast) responsiveness to estrogen. In other words, the breast gland is extremely sensitive to estrogen and grows abnormally large. Onset occurs in adolescence and does not regress with time. This results in heavy pendulous breasts that portends to poor posture resulting in back pain, neck pain, bra strap grooving, and rashes at the breast fold. Commonly, quality of life is affe... Continue reading
A 36-year-old female who had a previous abdominoplasty (tummy tuck) years ago by a different surgeon was dissatisfied with the contour of her lower abdominal wall. Next to the scar the abdominal wall was uneven (photo below). Her goal was an even or smooth contour across the scar line.
Principles of scar revision to ensure an optimal scar and an even contour include:Decreasing tension on the wound
The hairline offers a unique surgical access to the forehead for brow repositioning without moving the hairline backward (posterior). The goal of the pretrichial brow lift is to raise the brow and remove transverse forehead wrinkles. For characteristics of the aesthetic brow click here. For obvious reason, hiding the scar is of upmost importance for a successful outcome. If... Continue reading
The goal of liposuction is not weight loss. When we gain weight, we gain it proportionately throughout our bodies. However, when we lose weight we lose it disproportionately. Some areas persist no matter how much diet and exercise is performed. Thus, the role of liposuction is to help alleviate those persistent areas. Common persistent areas include the lower abdomen, “love-handles”, thighs, and the double-chin.
Ca... Continue reading
Implant augmentation of the breasts is the single most common plastic surgery procedure. In 2016, well over 290,000 augmentations were performed in the USA. This is an increase of 37% since year 2000 according to the American Society of Plastic Surgeons (ASPS). Additionally, 84% of breast implants placed in 2016 were silicone and 16% saline. Silicone implants are more common because of the natural feel, less folding or rippling, and there is no risk of deflation.
Because of gravity and changing tissue elasticity, the breasts change shape as we age and especially change after child birth and breast feeding. The goal of a mastopexy or breast lift is to reshape the breast mound and reposition the nipple areolar complex. The combination of these two techniques restore the youthful contour to the breast.
A young female who had a previously breast fed desired... Continue reading
Fat grafting or fat transfer is the process of harvesting fat by liposuction and dispensing that fat to another area of the body. A multitude of applications exist for fat grafting in cosmetic and reconstructive surgery. However, the three most common anatomical sites are the breasts, buttocks, and face.
30 y/o female desiring a natural increased shape to her breasts without the use of a foreign... Continue reading
The fleur-de-lis abdominoplasty is a technique to contour the abdominal wall when vertical as well as horizontal skin excess exists. Often patients who have had bariatric procedures to aid in weight loss fall into this category. In order optimize abdominal contour after weight loss, skin and adipose (fat) tissue are excised in two different directions instead of only one direction as in the traditional abdominoplasty (see image below).
I have always enjoyed learning anatomy and consequently this is one of the reasons I became a plastic surgeon. Plastic surgery demands an understanding of anatomy in more locations of the body than other surgical disciplines because we operate in more locations of the body.
For instance, published in the plastic surgery literature decades ago, Huger defined blood supply zones of the abdominal wall as illustrated in the figure below. ... Continue reading
The abdominoplasty or “Tummy Tuck” procedure can vary tremendously by techniques utilized and the preferences of your plastic surgeon. If you are considering an abdominoplasty be sure to educate yourself regarding the nuances of abdominoplasty. For instance, will drains be used or are progressive tension sutures placed to eliminate the need for drains? Where will the scar be located? Will the mons pubis be distorted? Will there be a vertical scar from where the navel was previous... Continue reading
In 2015, more than 127,000 abdominoplasties were performed in the USA as published by the American Society of Plastic Surgery. It is an incredibly common body contouring surgery. The question that you have to ask yourself in preparation for an abdominoplasty is “Am I willing to accept a scar in exchange for receiving the body contour I desire?”
Are all Tummy Tucks Equal?
Although the abdominoplasty proced... Continue reading
The submentum refers to the central region of the upper neck behind the chin. Submentoplasty means to reshape the submentum. Unlike a formal neck lift, the submentoplasty surgical site is isolated to the submentum.
The procedure is ideally performed on younger candidates without lax or excess skin. If lax or excess skin exists, a formal neck lift or even a facelift may be indicated.
A chronic wound can severely alter your quality of life and despite the best medical and surgical therapy, a chronic wound may persist and result in eventual amputation. Everyone has heard of stem cells but did you know that direct injection of adipose derived stem cells into a chronic wound has helped break the chronic wound cycle avoiding amputation?
Published this month in Stem Cell Research, surgeons from Nicaragua harvested stem ce... Continue reading
Breast reduction is a very common plastic surgery operation and has one of the highest patient satisfaction rates. Breast reduction is effective in improving:
Intertriginous changes (rashes between the breast and breast fold).
Importantly, breast reduction not only removes extra breast tissue but also provides a breast lift improving contour, nipple position, and projection. Both... Continue reading
Gluteal reshaping (gluteoplasty) can be performed with an implant or as fat grafting (Brazilian Butt Lift). These techniques are excellent for augmentation but have limitations with a ptotic or sagging buttock. Additionally, an implant is a foreign body... Continue reading
Luke Gutwein, MD
Plastic & Reconstructive Surgeon
St. Augustine's Medical Services
American Board of Surgery Certified
Professor of Anatomy
St. George's University
Grenada, West Indies
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