Cosmetic Surgery 

What is a Tummy Tuck?

A tummy tuck is a cosmetic procedure designed to remove excess skin from the abdomen and tighten laxity if present in the abdominal muscles. This laxity and excessive skin is likely to occur after pregnancy or significant weight changes.

How is Tummy Tuck surgery performed?

In the traditional abdominoplasty an incision is made in the bikini line and the excess skin is pulled down and inward, and is removed along with underlying fatty tissue. The muscles are tightened as required, the skin is carefully re-draped and the incision closed with several layers of dissolvable suture.

The Avelar abdominoplasty is a tummy tuck which the abdomen undergoes liposuction first then the removal of excess skin and lastly the tightening of the muscle laxity if needed. The clear advantage to this procedure is volume reduction of the abdomen as well as the other benefits of the traditional procedure usually without drains post operatively and rarely any significant pain. Recovery time from a tummy tuck takes about 1 week to return to normal activities.  

Liposuction

Liposuction is a common cosmetic procedure where fat under the skin is permanently removed that is resistant to diet and exercise modification. These areas include the hips, thighs, abdomen, and knees. Liposuction is ideal in people with good skin tone who have troublesome fatty deposits. It is not a treatment for obesity.

How is liposuction performed?

Liposuction is done under general anesthesia on an outpatient basis in a hospital or surgical center. The surgeon makes small discreet incisions in the areas to be treated. A cannula is inserted in a small incision and attached to a suction machine. The procedure may take an hour or more, depending on how many areas are involved. Body contours made irregular by fat can be improved by this procedure. Liposuction cannot correct contours that are irregular for other reasons, such as muscle weakness or hernia. However, combined with other procedures, liposuction can correct these other deformities with good results.

Recovery from liposuction is relatively easy. There is bruising after liposuction that will last 2 weeks. You will wear special garments provided to apply pressure, minimize swelling and provide support while healing. These garments also assist in retraction of the skin. Results are recognizable almost immediately and you will continue to see improvement over the next 12 weeks. The day after surgery you will be up and walking around. Increase your activity daily until full activity is resumed at two weeks.

Cosmetic Surgery Following Weight Loss

Gastric bypass, gastric banding, and significant weight loss may cause abnormal stretching of the skin and tissue, which may produce undesirable bulging in certain areas of the body. There are several surgical procedures that can be performed to alleviate these body issues.

In the upper body:

• An arm reduction can eradicate excess hanging skin of the upper arms to significantly reduce their size.
• Breast reduction surgery can alleviate the discomfort associated with large breasts. It may improve your mobility, ease the pain and irritation, and make you less self-conscious regarding your large bust.
• A breast lift can correct sagging or dissatisfaction with breast shape by removing the sagging tissue and repositioning the nipple.

On the trunk and legs:

• Tummy tuck surgery can remove excess skin and tissue from the abdomen and tighten the abdominal muscles.
• Thigh lift surgery, in its various forms, can remove loose skin and residual tissue of the upper and inner thigh.

After massive weight loss, the right surgical procedures can restore your confidence.
You will feel better and more comfortable about you and the way you look.

Breast Augmentation

Breast augmentation is a cosmetic procedure designed to enhance the body contour of a woman unhappy with her breast size. It may also be used to correct volume loss after pregnancy, or to help balance breast size asymmetries, as well as a reconstructive technique following other breast surgery.

While breast augmentation will enlarge the breasts, it will not alter basic defects in breast shape or form. Major asymmetries may be improved, but will not be completely corrected. A slight difference in the size or shape of the two breasts is considered normal and should not be a cause for concern. If breast size or nipple position asymmetries are severe then additional procedures to further improve symmetry may be necessary. Experience with this operation has demonstrated it to have highly satisfactory results for the majority of patients who are considered suitable candidates for the surgery.

A breast implant is placed through an incision, under the breast tissue or under the muscle. The incision can be made around the lower areola. It generally takes one and a half to two hours to complete the entire procedure. A breast implant is composed of an outer silicone shell filled with saline or silicone gel. The outer surface may be smooth or textured, and implants come in various shapes to meet the individual woman's needs.

Silicone breast implants

Silicone implants were first popularized in the 1960's. Controversy in the early 1990's led to widespread fear about the possibility of silicone breast implants causing autoimmune diseases in women. Extensive studies since then have showed no evidence that silicone breast implants have any relationship to breast cancer, autoimmune disease or any other systemic illnesses in patients. Specifically, patients with breast implants have no higher incidence of diseases such as rheumatoid arthritis, scleroderma or lupus, in comparison with the general population. The Food & Drug Administration approved the use of the third generation silicone gel implants in November of 2006 for women 22 years of age and older. These implants are not filled with liquid silicone, but rather a cohesive silicone gel. The increased safety of the cohesive gel implants led to the FDA's approval of these implants for cosmetic use. Saline implants are FDA approved for breast augmentation in women 18 years of age and older. There is no perfect breast implant and both the saline and silicone gel implants have advantages and disadvantages

Choosing the size and shape of your breast implants

The shape of your augmented breasts depends on the implant size and shape along with how your breast appear prior to surgery. The same size and shaped implant on one patient can look completely different on someone else. Therefore, one should avoid picking a size or shape solely on what ‘looks good' on someone else.

Many patients desire fuller cleavage. Although larger implants will give more cleavage, the patient's nipple position, chest shape and breast shape largely determine the amount cleavage that can be achieved. During your consultation and pre-operative visit the staff will with help you determine the implant size by placing actual filled implants of various sizes in special surgical bras to help estimate the size you desire. You may want to bring different shirts to see how your new look appears in different clothing. The final decision is yours and you will need to decide on an implant size at your preoperative appointment the week before surgery. Recovery from breast augmentation takes a week for resumption of normal activities.

Breast Lift - Mastopexy

Breast lift surgery, or mastopexy, restores a more youthful appearance to a woman's breasts. Over the years breasts can lose their shape and firmness due to pregnancy, nursing and loss of skin elasticity, causing them to sag. A breast lift will raise and reshape breasts-slowing the effects of aging and gravity. This procedure can also reduce the size of the areola, the darker skin surrounding the nipple if the patient desires. A breast lift does not increase the fullness of the upper portion of the breast; it simply allows removal of sagging breast tissue and repositioning of the nipple. For this reason, breast lifts are commonly performed in conjunction with breast augmentation (implants) to increase the fullness and improve the shape of the breasts. If you are planning a future pregnancy though, it is advisable to postpone your breast lift as pregnancy will likely cause further stretching and droop to the breasts. As with all cosmetic surgery, realistic expectations and emotional stability are important. Though breasts of any size can be lifted, women with smaller breasts enjoy longer lasting results.

How is breast lift surgery performed?

Though not a simple operation, breast lift surgery is generally safe when performed by a qualified cosmetic surgeon. The surgery may take between 1 1/2 to 3 1/2 hours. The incisions are around the nipple, vertically beneath the nipple and sometimes also horizontally in the crease of the breast. The breast tissue is reshaped and some breast tissue and skin is removed. The nipple and areola are then repositioned. The skin is closed with dissolvable sutures.

Breast Reduction

Large breasts can cause problems in many aspects of a woman's life. When they are larger than the usual standards of attractiveness in our society, the breasts are considered aesthetically displeasing. A full-breasted woman may appear heavier than she really is and she may have difficulty obtaining stylish clothing. In some cases, it may even be difficult to find a properly fitting bra. Often, women with large breasts feel very self-conscious. Teenagers may not develop proper poise and posture as they try to hide the fullness of their breasts, a subject they are unlikely to discuss freely with their parents.
The actual weight and bulk of the breasts may cause physical problems and symptoms that compound the feeling of unattractiveness. There can be a feeling of uncomfortable fullness, neck or back pain, and shoulder grooving. These symptoms may contribute to limited performance in certain occupations and in sports.

Finally, large breasts can also be difficult to assess for lumps or masses, thus making cancer detection much more difficult for the patient or for her physician. This may well be a source of further anxiety in a patient who is already embarrassed about her condition. Because of these medical problems, in many cases, medical insurance may cover some of the cost of breast reduction.

The goal of breast reduction surgery is to reduce and reshape the breasts. The breasts are made smaller. The nipple areola complex is repositioned upward, and if indicated, reduced in size. Excess skin and breast tissue is removed from the lower and outer portions of the breast.

How is breast reduction surgery performed?

Incisions are made in the lower breast resulting in three scars: one around the nipple, which usually heals very nicely; a vertical incision from the nipple to beneath the breast, which remains visible; and finally, an incision in the fold beneath the breast. The nipple remains attached to the deeper breast tissue. The remaining breast is folded around the nipple and its attachments and the incisions are closed. Care is taken to close these incisions as carefully as possible. Nevertheless, patients must realize that resultant scarring is as much a factor of tissue response as it is surgical skill, and occasionally wide scars can form despite a nice overall breast shape. With time, these scars do tend to blend into the normal skin, becoming less noticeable. Sometimes, we can perform a short scar breast reduction technique or vertical mammaplasty technique to limit the incisions used. We will determine if you are a candidate for this at your consultation.

All surgeries have risks and benefits which have to be weighed by the well informed patient after counseling with their surgeon.