An early follow-up on A mother of 2 in her mid 30’s who has had 6 pregnancies and 4 miscarriages. She is troubled by the wrinkled appearance of her abdominal skin as well as bulging of the abdomen which makes it difficult for her to wear fitted clothes. She mentions that each time that she looks at her abdomen, it reminds her of the many miscarriages.
She is shown before and again, just 7 weeks after abdominoplasty. It is important to place the scar in a low, “thong” position even if it means closing the umbilical aperture as a small vertical slit in the lower abdomen. Scars typically get thicker for 6 weeks and then begin to fade and improve over the next 2 years. Swelling, especially in the lower abdomen takes 6 months to resolve after surgery.
Already she is thrilled with her early result. She shared with me that she finally had the confidence to apply for a job that she wanted and got it!
A woman in her mid 20’s who is bothered by fatty deposits in the armpit area. (“Lipodystrophy of the axilla”) It has been present since she developed breasts, and bulges out of her bra and clothing. She is shown before and again, 6 weeks after power assisted liposuction using the S.A.F.E. technique. ( Suction Aspiration Fat Equalization) Under general anesthesia in the operating room, dilute local anesthetic solution is injected in each area. Then a cannula with raised fins on the end (“Becker cannula”) is used to mechanically break up the fat, using a power device that vibrates the cannula back and forth. This breaks up the fat but does not damage its viability. Then liposuction is performed using the same powered device but with a non finned cannula. Then the finned cannula is used again, without suction, to smooth and redistribute the remaining fat. In this way, I am able to obtain the smoothest removal of the fat with less chance of leaving irregularities. This procedure is commonly performed when needed at the time of a breast reduction, but can also be done by itself, as shown here.
An early ( 6 week ) follow-up on a woman in her later 50’s who is bothered by the weight of her 38 D cup breasts as well as looseness of the skin in her back. She had grooving and irritation of her shoulders from her bra straps, back pain and difficulty with her posture. She did not have enough breast tissue to be removed to be covered by her insurance company but decided to proceed on a cosmetic basis. She is shown just 6 weeks after bilateral breast reduction combined with a bra-line back lift. She had 219 gms of tissue removed from her right breast and 313 gms from her left breast to bring her down to a c cup. Her shoulder and back pain have resolved, and she loves her new shape and size. A bra-line back lift places the scar directly under the bra strap area. Scars are at their reddest and thickest at 6 weeks and will now start to fade and improve over the next 2 years or longer. I have recommended topical silicone to help the scars fade.
A man in his 60’s who has gynecomastia and significant weight loss. The only way to tighten loose skin is to remove skin, leaving a visible scar on the chest in exchange for a normal contour in clothing. Our patient is shown before and again, 4 years after bilateral gynecomastia excision with free nipple grafting. He is pleased by his contour in fitted shirts and bicycle jerseys, but, as we see with most gynecomastia patients who need skin excision, he does not feel comfortable taking his shirt off at the beach.
An early follow-up on a Fleur de Lis abdominoplasty in a man in his early 40’s who has lost 80 lbs with a keto diet. He has a large hernia of his umbilicus which was corrected at the same time by his general surgeon. A new umbilicus ( neoumbilicus) was created at the time of his surgery. “Fleur de Lis” refers to the pattern of skin excision which includes a vertical component. Many patients with significant weight loss have a horizontal excess of the upper abdomen which requires a vertical excision to tighten it. A vertical scar is the tradeoff. Our patient is shown before and again, just 2 months after his surgery. Scars are typically the thickest and reddest at 6 weeks after surgery and then will fade and improve over the next 2 years. Swelling of the abdomen also takes 6 months to fully resolve after an abdominoplasty. A dramatic early improvement is seen.
Update: A 9 month fu showns resolution of swelling and a dramatic improvement despite the gain of 5 lbs since surgery. Scar continues to fade and improve. And the new umbilicus that we created looks natural.
A woman in her early 60’s who is bothered by breast hypertrophy and describes herself as a 36 double D cup. She has had symptoms for many years of neck, back and shoulder pain, grooving and irritation of her shoulders from the bra straps, a rash under the breasts in the summer months, and problems with her posture. She also has fatty deposits in the anterior axilla ( armpit area)
She is shown before and again, 5 months after bilateral breast reduction along with power assisted liposuction using the S.A.F.E. technique ( suction aspiration fat equalization) to the lateral breast and anterior axillary area. Scars typically will continue to fade and improve for the first two years. Her symptoms are gone and she loves the new contour and looks forward to wearing evening dresses the show the upper breast and shoulders without the unsightly bulges in the anterior axilla.
A mother of twins in her early 40’s who is bothered by the rolls of skin, bulging of the abdomen in fitted clothing and looseness of the skin. Sh is 5’4” and 140 lbs and is shown before and again, 6 months after an extended abdominoplasty. An extended abdominoplasty extends the incision along the sides when needed and gives better tightening of the anterior flanks. The scar is hidden in a “thong” position where it can be covered by most clothing styles. A hollow has been sculpted around the umbilicus and a “champagne groove” above the umbilicus to give the abdomen a more attractive shape. Tattoos have been blurred for her privacy.
A woman in her early 70’s who is bothered by laxity of the back skin. She asked about liposuction but this does not tighten loose skin and as we age the skin becomes less elastic. The most reliable way to tighten loose skin is to remove a piece. She is shown before and again, just 6 weeks after a bra-line back lift. With a bra line back lift, the back skin is lifted and the scar is hidden under the bra line. The skin in the flank area is pulled up as well.
A mother of 4 in her later 40’s who is bothered by bulging and laxity of her stomach in clothing and in a two-piece bathing suit. She is shown before and again, nearly 6 months after an abdominoplasty. EXPAREL was used to limit her pain and need for narcotics after surgery.
Her case illustrates the importance of proper scar placement, putting the scar in a “thong” position even if it means a vertical slit scar is needed in the lower abdomen from the opening that is made around the umbilicus as the skin is pulled down. The alternative would be to put the entire scar higher where it would be visible on the abdomen. Scars typically become redder and thicker for 6 weeks and then begin to fade and improve over the next 2 years or longer. At nearly 6 months the scar still has some redness but is improving with topical silicone.
A woman in early 40’s who has lost 130 lbs with a gastric bypass, reducing her weight from 280 lbs to 152 lbs She is 5’ 3 ½” tall. She is bothered by looseness of the upper arm skin and back skin. She is shown just before and again, just 4 months after a bilateral “L” brachioplasty ( “arm lift)” done at the same time as a bra-line back lift. A posterior arm incision placement was chosen. Scars from a brachioplasty will typically get redder and thicker for 6 weeks and then slowly improve over the following 3 years. At must 4 months her scars are starting to fade. She is thrilled and told me about being thilled to be able to wear a sleeveless dress to a wedding recently and being able to dance without loose skin on her arms shaking and jiggling.