Tummy Tuck & Body Contouring

Breast Augmentation Revision

2012-02-01T16:22:00.000-08:00

Breast Augmentation Revision

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.

What is breast augmentation revision?

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:

1) Implant related problems of breast augmentation:

a) implant too big

b) implant too small

c) implants not the ideal size difference for symmetry

d) implant diameter too small

e) implant diameter too big

f) implant projection too small

g) implant projection too big

h) desire for silicone instead of saline (and vice versa)

2) Breast pocket related problems of breast augmentation

i) breast pocket too wide on the side (aka laterally, this is most common).

j) breast pocket too wide near the cleavage causing either too much cleavage or symmastia (inner breast borders touch)

k) breast fold too low

l) breast fold too high

m) breast fold shape not ideal

n) upper breast pocket dissected to much (breast implant migrates toward the clavicle when laying down)

o) breast pockets not symmetric

3) Breast tissue problems with breast augmentation

p) breast tissue too thin and implant visibility or palpability is an issue

q) animation. Breasts move too much when pectoralis muscle is flexed

r) capsule contracture. The capsule around the breast is excessively thick resulting in firm and/or painful breasts.

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.

All the best,

Dr Remus Repta

Phoenix/Scottsdale, AZ

Combined breast augmentation and breast lift

2012-01-29T07:26:00.000-08:00

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 breast augmentation and breast lift and I thought I would do a quick summary on the blog for everyone else.

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.

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.

1) Breast lifts that are designed to lift the areola higher up on the breast mound

2) Breast lifts that are designed to reshape and reposition the lower breast tissue higher by reducing laxity through removal of excess skin.

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.

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.

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.

All the best,

Dr Remus Repta

Phoenix/Scottsdale, AZ

Facial Rejuvenation

2012-01-04T18:31:00.000-08:00

Although 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.

Facial Rejuvenation

Aging is a process that involves more than just an increase in loose skin. Here are the three main components of aging.

1) Atrophy/volume loss: 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.

2) Soft-tissue laxity: 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.

3) Skin aging: 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.

So how do we reverse facial aging?

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.

1) Atrophy/volume loss:

Short term treatment: 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 fillers .

Long term treatment: There are really only two long term (10+ years) or permanent treatment options for facial volume rejuvenation and those are facial implants and fat grafting. 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.

2) Soft-tissue laxity:

Short term treatment: 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 Ulthera 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.

Long term treatment: Long term treatment of soft-tissue laxity is largely confined to surgical procedures such as face lift, neck lift, eye lid lift, and brow lift among others. 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.

3) Skin Aging:

Short term treatment: 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 Botox to relax skin wrinkles caused by facial muscle movement, light chemical peels, laser, and microdermabrasion for light skin resurfacing, IPL 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.

Long term treatment: 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.

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.

Below is a quick two question survey regarding preference for short term vs long term facial rejuvenation treatments. Thanks.

Quizzes by Quibblo.com | SnapApp Quiz Apps

All the best,

Dr Remus Repta

Phoenix/Scottsdale, AZ

Arm rejuvenation

2011-08-03T21:33:00.000-07:00

Younger, tighter, arms.

A common complaint of many women with regards to the aging process is the shape and appearance of their upper arms. 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. Many women report that the youthful contour of their arms is difficult to maintain through diet and exercise. Patient report a looseness and laxity of the arms that can be seen and felt spanning from the arm pit to the elbow. The severity of the problem varies from one individual to another and can be best understood as four different categories:

Category 1: In the first category, the unwanted shape of the upper arm is primarily a result of excess fat. The quality and tone of the skin is relatively good. These individuals respond well to volume loss either by additional diet and exercise or through liposuction or non-invasive fat reduction technologies. More information on this last part with the next blog entry on non-invasive fat and soft tissue treatment technology.

Category 2: 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). 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. An example of this type of non-invasive therapy is Ulthera. Which modality would be best is determined by the extent of the laxity as well as the goal of the patient.

Category 3: Skin and soft tissue laxity is present throughout the entire length of the upper arm. These individuals are often best treated by a full arm lift requiring an incision the length of the upper arm. 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. 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.

Category 4: Skin laxity is present primarily just above the elbows. These patients have traditionally been the most difficult to treat as the options have been limited. 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. 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.

All the best,

Dr. Remus Repta

Phoenix/Scottsdale Plastic Surgery

Laxity: what is it, what causes it, and how do we fix it.

2011-07-20T07:23:00.000-07:00

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.

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.

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.

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.

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.

Full body lift: The body lift is the cornerstone procedure in the rejuvenation process following significant weight loss. It allows complete correction of the abdomen, the hips, the buttocks, as well as the back and sides of the thighs. The body lift procedure also results in lifting and tightening of the mons pubis. 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. It can be combined with liposuction or with a procedure known as purse-string gluteoplasty that is designed to use your own tissue that would have been removed to add volume to the buttocks.

Brachioplasty: There are a handful of different options designed to improve the appearance of the arms following weight loss. The procedure of choice depends on the amount of skin and soft-tissue laxity present and the amount of improvement desired. The final incision can be in the arm pit or in the middle part of the inner arm surface.

Breast augmentation and lift: Most patients who have experiences significant weight loss require a breast lift to improve the shape and position of their breasts. A breast lift or mastopexy can be combined with an augmentation to restore the breast volume. 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. During your consultation Dr. Repta can discuss which combination of procedures will best give you the result that you are looking for.

Bra Line Back Lift: 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. Liposuction alone will not correct these areas since in addition to some excess fat there is often a significant amount of excess laxity. The final incision line of the Bra Line Back Lift is placed in the horizontal part of the brassiere strap. 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.

Thigh Lift: 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. These include the crescent thigh lift and the vertical thigh lift. 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.

Face and Neck Rejuvenation: 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. A variety of facial rejuvenation procedures are available to help you achieve your goal. Although weight loss has been the primary goal, the face often needs a healthy amount of volume to maintain its youthful shape and contour. Fat grafting for volume replenishment of the face is an integral component of facial rejuvenation following significant weigh loss.

All the best,

Dr. Remus Repta

Phoenix/Scottdale, AZ

Better looking thighs.

2011-05-14T17:26:00.000-07:00

One of the most common body contouring requests involves the thighs. Women, and sometimes men, of all ages have variable complaints about the appearance of their thighs. Problem areas may be the inner thighs, the outer thighs, front part of the thighs, and of course the back part of the thighs. 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. The problem or issue that requires improvement usually falls into one or both of the following categories:

1) Excess fat

2) Excess laxity

Excess fat

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”. Excess fat is one of the easier problems to fix. There are various forms of fat removal available including that fall into various categories including non-invasive, invasive, immediate improvement, delayed improvement, etc. 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. 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. These can be performed under local or general anesthesia and usually involve one or more small, 2-3 mm, access incisions. 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.

Excess laxity

Excess soft-tissue laxity of the thighs is a very frequent complaint from patients. 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. 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. 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. Excess laxity of the thighs can be treated by various forms of lifts as described below:

1) Back of the thigh: the back of the thighs or “posterior” thighs can be lifted and tightened by performing a buttock lift. By repositioning and tightening the buttock the posterior thigh is also lifted and tightened. The final incision is in the bikini line at the junction between the buttock and lower back. This incision can be well hidden and heals very well if performed properly. This procedure usually creates substantial improvement in the shape, position, and contour of both the buttock and thighs. It can also be combined with liposuction and fat grafting of the buttock to achieve maximum improvement in the appearance of the buttocks area.

2) Inner thigh: The inner thighs can be treated for excess laxity in one of two ways. 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. 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. This can potentially span the entire length of the inner thigh from groin to the knee area. Although the scar is long, the reduction of laxity is significant and the results are usually the longest lasting. Massive weight loss patients are usually good candidates for this procedure. 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. This procedure has a more concealable scar but its ability to remove tissue laxity is much less than the vertical thigh lift procedure. 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.

3) Body lift: The body lift procedure involves a tummy tuck, lateral (side) thigh lift, and buttock lift. 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. The inner thighs may require additional treatment for maximum correction as indicated in #2 above. This can be done at the same time or as a separate surgical proceure.

All the best,

Dr. Remus Repta

Phoenix/Scottsdale

Decisions in breast lift surgery. Incisions, scars, and breast shape.

2011-04-26T21:09:00.000-07:00

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.

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.

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.

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.

All the best,

Dr. Remus Repta

Board Certified Plastic Surgeon

Phoenix/Scottsdale AZ

Capsule contracture

2011-03-28T16:38:00.000-07:00

What is capsule contracture?

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.

Why does capsule contacture occur?

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.

How is capsule contracture prevented?

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.

How is capsule contracture corrected once it forms?

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:

1) Removal of all breast capsule (full capsulectomy)

2) Replacement of the implant with a new implant (implant exchange)

3) Placement of the new implant in a newly formed pocket (neo pocket creation)

4) +/- use of a drain, massage, singulair, etc.

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.

Sincerely,

Dr. Remus Repta

Phoenix Scottsdale plastic surgery

Gynecomastia---Getting the weight off your chest.

2011-01-20T09:40:00.000-08:00

What is gynecomastia?

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.

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.

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.

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.

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.

In terms of anesthesia, both local anesthesia or IV sedation/general anesthesia can be performed based on patient preference and body characteristics.

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.

All the best,

Dr. Remus Repta

Phoenix/Scottsdale, AZ

Dont Sweat It

2010-05-12T10:58:00.000-07:00

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

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

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

All the best,

Dr. Remus Repta

Tummy Tuck Scars

2010-04-11T10:15:00.000-07:00

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

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

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

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

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

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

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

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

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

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

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

All the best,

Dr. Remus Repta

Tummy Tuck Repair

2010-02-04T07:53:00.000-08:00

What is Tummy Tuck Revision?

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

List of potential tummy tuck issues:

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

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

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

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

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

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

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

All the best,

Dr. Remus Repta

Circumferential tummy tuck (Body Lift)

2009-09-01T13:08:00.000-07:00

What is a Body Lift or Circumferential tummy tuck?

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.

Who is a candidate for a Body Lift?

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.

Where are the incisions?

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.

All the best,

Dr. Remus Repta

Lip Augmentation

2009-08-27T14:59:00.000-07:00

How can lips be made fuller, younger looking?

Recently I was interviewed by a local new station regarding the new PermaLip implant. 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.

Other options for achieving fuller lips include using hyaluronic acid fillers (juvederm, restylane, etc), injecting fat, or placing various types of material including fascia, skin, and goretex.

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.

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.

All the best,

Dr. Remus Repta

Breast Augmentation

2009-08-12T14:17:00.000-07:00

Breast Augmentation

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.

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.

Implant types

Saline

Smooth shell

Textured

Silicone (gummy bear)

Smooth shell

Textured shell

Silicone (form stable)

Textured shell only

Fat

Incision location

Peri-areolar (at the border of the areola and breast skin)

Trans-axillary (through the arm pit)

Inframmamary (at the breast fold/under the breast)

Trans-umbilical (aka TUBA, through the belly button)

Placement

Sub-glandular (under the breast gland)

Sub-fascial (under the covering on top of the muscle)

Sub-pectoral (under the muscle)

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 implant type, incision location, and placement.

Breast implant type

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.

Incision location

The location of the incision for placement of the breast implant is determined by patient preference but also by implant type and implant size.

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.

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.

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.

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.

Implant placement

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.

I hope this helps. More to come in the near future about breast augmentation.

All the best,

Dr. Remus Repta

Buttock Fat Grafting

2009-04-26T11:06:00.000-07:00

What is buttock fat grafting?

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).

When is buttocks fat grafting performed?

It is performed most commonly for augmentation, or increasing the size of the buttocks, as well as shaping and correcting contour irregularities.

What are the benefits of fat grafting?

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.

What are the drawbacks of buttocks fat grafting?

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.

What is the recovery time like?

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.

Stay tuned for buttocks augmentation using implants as the next blog entry.

All the best,

Dr. Repta

Phoenix/Scottsdale Plastic Surgeon

2009-03-10T12:29:00.001-07:00

Dr Remus Repta

Phoenix/Scottsdale Plastic Surgeon

Buttock Lift

2009-01-15T14:40:00.000-08:00

What is a buttock lift?

Any procedure that removes excess skin and soft-tissue laxity to correct or improve the shape and contour of the buttocks can be referred to as a buttock lift.

As with any "lift" procedure--whether it is a breast lift, face lift, etc.--the amount of skin and soft tissue laxity that is present determines the extent of the incision and subsequent length of scar that is needed to correct the laxity and achieve the best contour possible.

Where is the scar located for a buttock lift?

The short answer is wherever the patient prefers it. The best location, however, is at the level and in the shape of the underwear line. Imagine a pair of appropriately sized and located underwear that are worn snug. The indentation of the underwear line gives a good idea where the final buttock lift incision should lay.

What is the recovery process like?

Surprisingly straightforward. Most of my patients who have undergone combination procedures including a buttock lift have reported that the recovery process was fairly easy with more of a general feeling tightness rather than significant discomfort.

No special restrictions are needed. Patients are allowed to sit and sleep on their back. I recommend using plenty of cushion and minimizing sitting in one place or position for extended periods of time.

Summary

The buttock lift procedure can be performed in a variety of ways but (no pun intended) the general idea is to remove the excess skin and soft-tissue laxity by resection tissue using an incision at the level of the top portion of the underwear line. It can be combined with buttocks augmentation or with a body lift (circumferential abdominoplasty). The recovery process is fairly straightforward.

All the best,

Dr. Repta

Phoenix/Scottsdale Plastic Surgeon

Buttocks Contouring

2009-01-06T13:08:00.000-08:00

In an earlier post we discussed buttocks fat grafting; the plasti sugery procedure designed to increase the size and shape of the buttocks through the method of removing fat from unwanted areas and grafting (injecting) the fat into the buttocks. Buttock fat grafting is actually a part of the the larger concept of buttock contouring. As with all cosmetic plastic surgery procedures, the right procedure should be tailored to each individual for their specific needs and goals.

Since the buttock area is a significant part of human health and sensuality, we will disuss in greater detail, over the next few weeks, the concept of buttock contouring.

What is buttocks contouring?

Buttocks contouring is the general term used to describe plastic surgery procedures that are used to improve the shape, size, and appearance of the buttocks. These collect group of procedures include:

Buttock:

-Lift

-Fat grafting

-Liposuction

-Implants

We have covered buttock fat grafting in an earlier post. Later this week we will discuss buttock lift. This procedure is designed to correct skin and sofy-tissue laxity. It may be used alone or in conjunction with other body contouring and/or buttock contouring procedures.

Stay tuned for the buttocks lift procedure later this week.

All the best,

Dr. Repta

Phoenix/Scottsdale Plastic Surgeon

Reverse Tummy Tuck

2008-11-15T10:12:00.000-08:00

Does this procedure really exist?

Yes, there is actually a procedure called "reverse tummy tuck" or "reverse abdominoplasty". We actually included a separate chapter on it in The Atlas of Abdominoplasty.

The reverse tummy tuck is a unique procedure designed to improve the shape and contour of the upper abdomen while hidding the final scar location in the breast fold.

Who is candidate for the reverse tummy tuck?

Good candidates for the reverse tummy tuck are usually not significantly overweight, have excess skin and soft-tissue laxity primarily above the belly button, and may also be planning on a breast procedure that will result in a breast at the breast fold. The last part is not a requirement since the scar is well concealed but certainly allows performing both the breast procedure and the reverse tummy tuck without additional scars.

Can muscle tightening be performed with reverse tummy tuck?

Yes. Most candidates for reverse tummy tuck are not in great need for muscle tightening, however, if it is deemed beneficial it can be performed. The process of muscle tightening with reverse tummy tuck is very similar to that performed with endoscopic tummy tuck (see earlier post on endoscopic tummy tuck).

Can liposuction be performed with reverse tummy tuck?

Yes. Liposuction can and is often used in combination with all of the tummy tuck procedures.

What about the belly button?

The belly button is usually not released during the reverse tummy tuck and therefore there is no scar around or inside the belly button. The upward pull of the reverse tummy tuck procedure has a natural rejuvenating effect.

Drains?

Although not manditory, drains are still highly recommended.

Look for posts on circumferential abdominoplasty in the near future.

All the best,

Dr. Remus Repta

Phoenix/Scottsdale Plastic Surgeon

Buttocks Fat Grafting

2008-10-25T06:19:00.000-07:00

What is buttocks fat grafting?

Buttocks fat grafting is a procedure designed to augment or increase the size of, as well as to improve the shape of the buttocks by using fat from other areas of the body.

The buttocks is a very important part of human sensuality. It is represented throughout different cultures past and present in art and fashion. Just as there are different procedures to improve the shape and appearence of breasts, so too are there a range of prcedures designed to shape and improve the size, shape, and appearence of the buttocks.

The procedure available to improve the size of the buttocks include implants, autologous flap (more on this procedure in later posts), and fat grafting.

How is buttocks fat grafting done?

Buttocks fat grafting is performed by removing fat from one area(s) of the body and using that fat to increase the volume and improve the shape of the buttocks. The fat is obtained through liposuction in a special manner. Any of the area of the body is a potential source for fat, with the abdomen, hips, thighs, flank, and back being the most common sources. Through liposuction fat is removed and the area being liposuctions is contoured to the desired effect. The fat is prepared in the operating room and reinjected into the buttocks through tiny incisions that are less than a few millimeters long.

Does buttocks fat grafting last?

Yes. Fat grafting has been around for some time now and it has been clearly shown that fat grafting does last. There is some debate about how much of the graft "takes" and how much gets absorbed, however, the fat that does take stays forever. Most plastic surgeons agree that at least 50% of the fat graft usually takes. In my experience, the percentage of fat that takes is more like 75%. This fat then increases or decreases with weight gain and weight loss respectively just like the rest of your body....since it actually is your body.

What can I expect after surgery?

The recovery for buttocks fat grafting is similar to most liposuction procedures. You'll have garments on the areas where liposuction has been performed, there will be some soreness but nothing too remarkable, you can do most activities as long as they are not strenuous, heavy, or prolonged. With regards to sitting, if the patient is comfortable and able, I recommend resting some of the time on your stomach since this will help with the swelling, otherwise when sitting it is important to have plenty of padding and to relieve some pressure periodically. Brusing and swelling will be present as expected.

Summary

I believe buttocks fat grafting is a wondeful procedure for patients that do not have enough volume in their buttocks. It works well, lasts the rest of your life if you mantain your weight and health status, and most importantly it feels real because it is real.

All the best,

Dr. Remus Repta

Extended Tummy Tuck

2008-10-08T15:40:00.000-07:00

Extended Tummy Tuck

What is the extended tummy tuck procedure?
The extended tummy tuck also referred to as extended abdominoplasty, is an abdominal cotouring procedure that is designed to remove a maximum amount of extra skin and soft-tissue laxity without a scar that goes all the way around the waist (circumferential tummy tuck or body lift). Most patients that have a significant amount of extra skin and soft-tissue laxity around the waist are best served by a body lift also known as a circumferential abdominoplasty. However, for various reasons, patients may either not want a body lift or may not be an ideal candidate to undergo the body lift procedure. In these cases the extended tummy tuck is a great procedure that will allow maximum improvement of the extra skin and soft-tissue laxity.

How long is the incision?
The short answer is that it is as long as your body needs it to be to remove the extra tissue without creating folds of tissue at the ends of the incision which may be seen when too short of an incision is used. By definition, the incision used for the extended tummy tuck is longer that a full tummy tuck procedure but shorter than a circumferential tummy tuck. As a general rule the extended tummy tuck incision spans from about one palm witdh beyond each hip bone on both sides or about 3-5 inches longer on both sides than a full tummy tuck.

What else is involved in the extended tummy tuck procedure?
The goal of the extended tummy tuck procedure is the same as any other tummy tuck procedure, namely to thin, to flatten, and to tighten. To accomplish this, liposuction of the abdomen, hips, and flanks is performed when needed/or deemed beneficial to the overall result. In addition, muscle tightening or muscle repair is also performed to help flatten the abdominal wall. Finally, the extra skin and soft-tissue is removed, allowing the tummy to be tighter in profile and shape.

Next up. The body lift or circumferential abdominoplasty.

All the best,
Dr. Remus Repta

Phoenix/Scottsdale Plastic Surgeon

Drains: Annoying but Necessary.

2008-09-29T16:51:00.000-07:00

Whats the deal with the drains?

The lowly drain must be one of the least appreciated and liked components of the tummy tuck procedure. They are nuisance to deal with early on, they get in the way, they require extra work to take care of and to record the output, and when you can't stand them anymore there is the hesitation or fear of having pulled out.

So are drains necessary following the tummy tuck procedure.

The simple answer is yes. Although there is a tummy tuck technique that does not require drains, lets call it the "French Method" since it got its start in France, the procedure in my opinion takes longer and gives a less powerful result than the tummy tuck techniques that do not require a drain.

The body naturally creates "healing" fluid whenever surgery is performed. When there is a large elevated or undermined area such as in the tummy tuck procedure, the amount of healing fluid is fairly large and there is a large space for it to accumulate if left alone. Some of this fluid will naturally result in scar tissue and/or pseudobursa (see previous post) if not properly managed. To prevent this, we place a drain(s) and use the compression of an abdominal binder to decrease its production, expedited its removal, and allow the abdominal soft-tissue to adhere to the underlying abdominal wall. The vast majority of the tummy tuck procedures including endoscopic, mini, full, extended, reverse, and circumfrential tummy tucks require both a drain and an abdominal binder.

How long is the drain(s) going to stay in?

I always like to answer this question with: "as long as your body needs it and not a day longer". This is an accurate answer since the length of time varies from individual to individual. I prefer to see about less than 25-30 ml of drain output per 24 hours. This usually takes about one week to ten days to achieve.

Doe it hurt to have the drain removed?

Again, it varies on the individual, type of drain, how its placed, etc. I honestly cannot remember the last time a patient did not remark how easy and painless drain removal actually was. I use a flutted or tapered drain, make sure the drain passes easily through the skin during surgery, place numbing medication at the skin site, and usually bring the drain out through the incision or just below it. This not only avoids an additional scar but this area is usually numb in the few weeks following surgery.

In summary, the drain, although annoying at times is necessary to get a great result. We want your tummy to be thin and flat and the extra scar tissue that would build up without a drain is just not acceptable in my opinion.

All the best,

Dr. Remus Repta

What is a Pseudo-bursa?

2008-09-20T00:43:00.001-07:00

Recently I have had a few questions about bulging or fullness following tummy tuck. While there are a handful of reasons for fullness to be noticed some time following the tummy tuck procedure I think the presence of pseudobursa is often under reported or underdiagnosed.

So what is a pseudobursa?

Simply put a pseudobursa is a pocket of extra thick scar tissue. Remember those drains that you had after the tummy tuck? They were necessary to prevent a seroma, or collection of "healing" fluid. Despite the use of drains, however, seroma can still ocurr. It is not hard to imagine that some seroma fluid accumulates after the drains are removed. Of course, the majority of the time the body keeps up with absorption of the seroma fluid and any extra fluid that may be under the abdominal soft-tissue is not noticed. The body naturally wants to isolate any free fluid between the abdominal soft tissue and the abdominal wall. The body knows that it does not belong there so it sends in cells to create scar tissue around the fluid. This scar tissue surrounding a fluid pocket is called a pseudobursa. If the wall of the pseudobursa is thin enough then they usually go undetected. Occasionaly a previously undetectable pseudobursa gets infected. When this ocurrs usually there is some tunneling and drainage at the nearest incision, either the lower incision in the midline or the belly button scar. If the pseudobursa contains a lot of fluid or the scar tissue is very thick it can be noticeable as a bulge or fullness.

The most common areas 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. Pseudobursa can also be seen 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.

How do you treat pseudobursa?

Although the pseudobursa can be injected with medicine to scar the two parts together and reduce the overall size, this is usually not that effective. If the pseudobursa is detected either by the development of infection or because it can be felt or seen as a bulge or fullness then it should be removed. The prior incision scar must be used to access the pseudobursa. The scar tissue is then removed, sutures are placed to obliterate the space where the pseudobursa was located, and drains as well as an abdominal binder are used similar to the original tummy tuck procedure. The recovery process is usually much easier than the original tummy tuck procedure with the exception of the drains and the abdominal binder.

Feel free to ask any questions that I may not have covered. Look for an extended tummy tuck post next.

All the best,

Dr. Remus Repta

Liposuction and the Tummy Tuck

2008-09-14T09:25:00.000-07:00

What is Liposuction?

Liposuction is the process of removing fat by using small cannulas that are inserted through tiny incisions in the skin. It is one of the most powerful discoveries in body contouring. Liposuction goes by many names these days including laser assisted lipo (LAL), ultrasound assisted lipo (UAL), power assisted lipo (PAL), etc. All of these modalities have differences and similarities, the final component, however, is always the use of tiny incisions to access fat underneath the skin.

Is there a role for Liposuction in Tummy Tucks?

Liposuction is an almost indispensible tool for giving the very best results possible for the tummy tuck procedure. Although not every tummy tuck candidate benefits from liposuction during the tummy tuck procedure, I would estimate that 90+ percent do.

How is Liposuction beneficial in Tummy Tucks?

In three different ways:

1) To thin the abdominal soft-tissue apron. Remenber, part of the primary goal of the tummy tuck procedure is to "Thin". Despite the fact that tissue will be removed with the tummy tuck procedure, the remaining tissue may and frequently is still relatively thick from an ideal cosmetic result standpoint. Liposuction can be used to uniformily thin the fat of the abdomen.

2) To contour the areas near the abdomen. The tummy tuck procedure will improve the contour of.......the abdomen. Frequently, the areas of the flank, hips, thighs, and near the bra/breast area may appear in contrast to the now improved tummy tuck contour. Liposuction can be used to contour these areas so that not only does the abdominal contour and silhouette look great, but your whole trunk area looks thinner, uniform, and beautiful.

3) To scultp the abdominal surface. I frequently will emphasize the vertical groove in the middle of the abdomen by using liposuction. This groove is sometimes referred to as the "Champagne Groove". (Google it for a colorful explanation). This is a very important part of the attractiveness of the abdomen, so I strive to create or improve it's appearence.

Are there some patients who are not candidates for Liposuction during their Tummy Tuck?

The short answer is yes. Some patients are higher risk for healing following tummy tuck. Patients who are heavy smokers, certain abdominal scars that may interrupt the blood supply to the abdominal skin and soft-tissue, etc., may not be candidates for the use of liposuction of the abdominal soft-tissue itself. Of course, liposuction can still be used in the areas around the abdomen to improve the overall contour of the trunk, but liposuction of the abdominal soft-tissue itself at the same time of the tummy tuck should be used with caution in this group of patients that present with increased risk of healing issues.

All the best,

Dr. Remus Repta

Bra Line Back Lift

2008-09-12T11:05:00.000-07:00

What is the Bra Line Back Lift?
The Bra Line Back Lift is a new procedure that helps correct the soft-tissue rolls and folds of the middle and upper back. There are a large number of women who complain about the presence of these soft-tissue folds. Many express the desire to wear form fitting clothes in the current fashions but hesitate to do so because of the appearance that these back rolls present. Until now, there was relatively little that could be offered to help these patients.The Bra Line Back Lift was co-authored by me and Dr. Hunstad. Scheduled to be published in the October 2008 issue of Plastic and Reconstructive Surgery Journal, the leading journal for the American Society of Plastic Surgery (ASPS), the Bra Line Back Lift procedure was designed to improve the appearance of the upper and middle back by correcting the presence of soft-tissue folds and rolls and allowing a smooth, even-flowing silhouette to be achieved. In recent weeks, there has been increasing media coverage of the procedure. Below are the details of the procedure including ideal candidates, recovery time, and additional information.
Who are candidates for the Bra Line Back lift?
There is actually a wide range of patients that could be good candidates for the Bra Line Back Lift procedure. We have noticed that the most frequent request is from patients that are in their 40’s or 50’s, are in relatively good shape, but because of either aging, excess sun exposure, or secondary to weight fluctuation, they have excess soft-tissue laxity in the upper and middle back that present as rolls and folds. It is important to note that skin and soft-tissue laxity cannot be exercised and therefore cannot be tightened. Liposuction alone has been used to treat these areas but this just improves the presence of fat and it does not correct the laxity of the skin and soft-tissue which is the main problem.
How long does it take and what is the recovery time?
The procedure takes about one hour. It is performed under general anesthesia and as an outpatient procedure. The recovery process is fairly easy as reported by many patients. There is often not a lot of discomfort and beside the restriction of heavy lifting and vigorous activity, the patients are usually allowed to increase their activity level as tolerated. Drains are usually not used and since all of the sutures are internal and dissolved by the body, there is no cumbersome dressing needed and patients are allowed to shower in 24-48 hours.
Are there any scars?
Yes. Scars are always created whenever surgery is performed। The Bra Line Back Lift has the benefit of placing the scar within the borders of the bra strap. In discussing the Bra Line Back lift procedure, I tell my patients that a visible scar will be present, that it will be hidden by the horizontal part of the bra strap, and that in the end, they are choosing between the presence of back rolls or a scar. The benefit of choosing to undergo the Bra Line Back Lift is that with all form fitting clothes, the folds are now gone and a smooth silhouette is present. With the exception of a backless dress or the very tiniest bikini top, the Bra Line Back Lift scar is usually well hidden.

Feel free to ask any questions that I might not have covered. Before and after photos can be seen in our office as well as in The Atlas of Abdominoplasty textbook.

All the best,
Dr. Remus Repta

Full (standard) Tummy Tuck

2008-09-09T10:12:00.000-07:00

The most frequently performed tummy tuck procedure is the full abdominoplasty technique. The reason for this is two fold: 1) most patients presenting for abdominal contouring or tummy tuck are good candidates for a full abdominoplasty, and 2) the full abdominoplasty is the original tummy tuck technique. It is performed the most frequently during training and it can provide good results for the widest range of patients.

So, what defines a full tummy tuck?

A full tummy tuck or abdominoplasty is best defines by the length of the lower incision as well as the release of the belly button from the abdominal skin and soft-tissue. Of course, most full abdominoplasty procedures also invlove muscle tightening if there is is abdominal wall laxity, and liposuction if there is excess adiposity (fat) in the abdominal soft-tissue and surrounding areas. However, it is the length of the incision and whether or not the belly button is released that trully defines a full abdominoplasty. The length of the incision usually spans the hip bones or ASIS (anterior superior iliac spines). It can be a little shorter or a little longer but not by much. A significantly shorter incision together with a belly button that is not detached from the surrounding skin and soft-tissue better defined as a mini-tummy tuck. Conversely, an incision that is much longer, that goes beyond the hip bones and onto the sides of the hips or flanks is better defined as an extended abdominoplasty (to be discussed in later post). The idea behind this is that an incision that extends onto the hips and flanks requires the patient to be rolled slightly during surgery in order to have access to these areas. Most importantly, however, an incision that goes beyond the hips bone and onto the side of the hips and flanks implies that the patient had significant exess soft-tissue laxity and the question then becomes whether a circumferential abdominoplasty (aks body lift, circumferential belt lipectomy, around the world abdominoplasty). I will discuss the circumferential abdomioplasty in great detail in a later post.

Who is not a good candidate for a full tummy tuck?

The very first answer to this question is anyone that is not healthy enough to undergo a full tummy tuck or any abdominal contouring procedure safely.

There are two groups of patients that are not ideal candidates for a full abdominoplasty. Those that do not have enough excess soft-tissue laxity and those that have two much soft-tissue laxity to benefit from the full tummy tuck. Of course there are some patients that would be better served by endoscopic tummy tuck or mini tummy tuck, as discussed in the previous posts. The other group of patients are those that have significant excess soft-tissue laxity. These patients would not get enough correction by limiting the incision up to the hip bones. If this is done one of two things usually results. The first is that the patient is left with laxity and will not be happy. The scond is that there can be folds of skin and soft-tissue at each end of the incision termed "dog-ears" (to be discussed in greater detail in later posts on complications). The reason for this is similar to pleating when clothing is tailored.

So, is the full tummy tuck a good procedure?

Absolutely. For the proper candidate the full tummy tuck is a great procedure. Procedure s are not inherently good or bad. They are good when performed properly for the appropriate patients and bad when performed poorly for patients that are not good candidates.

Next up. Use of liposuction in tummy tucks.

All the best,

Dr. Remus Repta

Endoscopic Abdominoplasty

2008-09-06T16:05:00.000-07:00

Endoscopic abdominoplatsy: It's high-tech, it's slick, and it only requires tiny incisions. The downside: Only a select group of tummy tuck patients are ideal candidates.

Endoscopic abdominoplasty can be thought of as minimally invasive tummy tuck procedure. To understand the usefulness of this procedure you may refer to the earlier posts made on this blog regarding the basic goal of all tummy tuck procedures. As you may remember, the main goals are generally to thin, tighten, and flatten the abdominal contour. We'll, there are some patients that really obtain the majority of the tummy tuck benefit from the flattening or muscle plication part of the tummy tuck procedure. In order to accomplish this the soft-tissue on top of the abdominal muscles and fascia (see myofascial plication in the Muscle Tightening post) are elevated to allow access for muscle tightening to occur. Using traditional methods, in order for this to occur, an appropriately long incision near waistline is needed to provide enough space to visualize the soft-tissue elevation and muscle tightening process. When the muscle tightening process is complete the extra soft-tissue laxity is removed and the incision is closed. For most tummy tuck patients this lower waistline incision is needed in order to allow removal of the excess soft-tissue laxity withouth creating folds of tissue at the sides often referred to as "dog-ears". For individuals who have very little excess soft-tissue laxity, however, that still require abdominal muscle plication (myofascial plication) the length of this waistline incision is a big price to pay just to allow muscle plication to occur. It is for these specific group of tummy tuck patients that endoscopic abdominoplasty is a great tummy tuck technique.

The basic details of the procedure are as follows. Most patients still benefit from some for of liposuction of the abdomen. This is usually performed first in a thorough and even manner. Following this, a very small incision perhaps only 2-3 inches long is made within the hairbearing portion of the pubic hair. This incision, once healed is essentially imperceptible and of course completly hidden by even the smallest of bikini bottoms. A second incision is made within the belly button. Through these two incision and with the use of a tiny camera and special instruments, the soft-tissue is elevated from the underling abdominal wall and muscle thightening is performed. In this manner, a patient with laxity of the abdominal wall, frequently seen after pregnancy, can regain the shape and contour of their abdomen without the need for any visible scars. Within a month or two, these patients can be poolside in a tiny bikini with a well toned abdomen making everyone wonder how they regained their body so fast and so well after having a child. :)

All the best,

Dr. Remus Repta

Muscle Tightening

2008-09-04T09:07:00.000-07:00

What is muscle tightening?

There is a fair amount of confusion about the process of "muscle tightening" during the tummy tuck procedure। The key to understanding this process is understanding the anatomy of the abdominal wall। The basic idea is that the muscles of the abdominal wall are all covered or enclosed in a thick tissue cover called fascia. This fascia, in part, maintains the general position of the abdominal muscles to one another, especially the "six-pack" muscles in the midline.
With age, pregnancy, and weight fluctuation, the abdominal wall (muscles and fascia) stretch to accomodate these changes. As you may imagine, the muscles have an easier time returing to their previous size and shape. The fascia, however, may remain streched since it does not have the same contractile properties of muscles. This results in a persistent roundness of the abdominal wall which presents as a fullness or "pooch" especially on side profile.
The process of abdominal wall tightening is really the process of abdominal wall fascia tightening। This is why I prefer the term "myofascial plication". It best describes the process of tightening the abdominal wall. When performing a tummy tuck, during the process of myofascial plication, I plicate of tightent the fascial covering of the abdominal wall and by doing so the abdominal wall muscles are returned to their youthful, pre-pregnancy/weight gain position. This process can be better visualized as tailoring the fabric of a dress or pants to better fit the body. The extra cloth is hemmed or plicated so that it matches and follows the contour of the body, allowing a boxy or oversized shaped to be molded to the underlying silhouette.

To tighten or not to tighten: Is muscle tigtening (myofascial plication) always needed?

The short answer is no. Muscle tightening is a very important part of the tummy tuck procedure. It allows the side and front profile to be improved, making the abdomen look flat from the side and hour-glass from the front. Some patients may simply have excess skin and soft-tissue without laxity in the abdominal wall. These patients may not need or benefit from muscle tightening. My experience is that most people who are candidates for a tummy tuck are also good candidates for muscle tightening. Of course, this is based on the needs, goals, and desires of each individual. I simply give my recommendation as if it were my body and explain the pros and cons of muscle tightening, and allow the patient to make the final decision. The downside of muscle tightening is some extra discomfort and a bit longer recovery process to get back to full speed. I have found that 99% of patients choose to undergo muscle tightening when it is explained.

All the best,

Dr. Remus Repta

Mini Tummy Tuck

2008-09-03T16:56:00.000-07:00

What is a mini tummy tuck?

The best description of a mini tummy tuck is that it has a shorter horizontal scar at the waistline without the need for a scar around the belly button. There is some variation to the other components of the mini tummy tuck procedure. This includes whether the abdominal wall is plicated/tighten and whether the stalk of the umbilicus is detached or left alone.

Often, the mini tummy tuck is performed by dissection of the soft-tissue up to the level of the belly button. The excess soft-tissue is removed, but there is no muscle tightening performed and the belly button stalk is usually left undisturbed. The decision of which components of the mini tummy tuck are performed should be based on the needs and goals of the patient.

Who is a candidate for the mini tummy tuck?

The ideal candidate for a mini tummy tuck is someone that is close to their normal body weight and who have some, but not a significant amount of excess skin and soft-tissue laxity. In essence, the mini tummy tuck patient does not have enough abdominal laxity that will safely allow resection of the excess skin and soft-tissue from the initial waistline incision up to and including the location of the belly button. A standard or full tummy tuck in these patients would create a vertical scar in the midline of the abdomen between the new location of the belly button and the location of the final waistline scar.

How long is the scar?

There is some flexibility in how long the scar of a mini tummy tuck can be. Although the exact length may vary, the ends of the scar should not go beyond the first prominent point of the pelvic bone. This point is referred to as the anterior superior iliac spine (ASIS). Any tummy tuck scar that extends beyond these points implies that the laxity of the abdominal soft-tissue were more than moderate and the patient may be a decent candidate for a standard full abdominoplasty.

What are the pros and cons of the mini tummy tuck?

The mini tummy tuck procedure is designed for patients that have some laxity of the abdominal soft-tissue but not enough to allow a full abdominoplasty to be performed. The pros are that the total length of the scar is shorter and the need for a scar around the belly button is avoided. The recovery time, cost, and the other variables may be quite similar since some surgeons, myself included, perform most of the other components of a standard tummy tuck if deemed beneficial to the overall result. These may include liposuction of the abdomen, hips, flank, and mons area as well tightening of the abdominal muscles. To do so, the belly button can be detached to allow access to the entire length of the abdominal muscles and then reattached at the completion of the case.

The cons are seen only when the mini tuck is used for patients that are not ideal candidates. These include patients with significant laxity, poor skin that may have stretch marks up to or beyond the belly button, and a belly button size, shape, and position that would benefit from rejuvenation. The mini tummy tuck is simply not designed to accomplish all of this.

We have mentioned, and will be discussing abdominal muscle tightening with many of the other tummy tuck procedures. In order to better understand this process a post specifically on abdominal muscle tightening or myofascial plication will be made in the next few days. Stay tuned.

All the best,

Dr. Remus Repta

Before we discuss specific tummy tuck techniques

2008-09-01T13:29:00.000-07:00

In order to understand the pros and cons of each different tummy tuck technique, we have to understand what a tummy tuck or abdominoplasty procedure is designed to accomplish.

Although the needs of each individual may be different, the final optimal outcome of all abdominal contouring procedures is very similar. These include:

1) Removal of excess skin and fat
2) Tightening of the abdominal wall
3) Rejuvenating the appearance of the belly button or umbilicus
4) Improving the overall contour and silhouette of mid-drift
5) And finally, doing all this with scars that are thin and well concealed by swimwear, undergarments, and summer wear.

As one of the leaders in body contouring has told me, "the goal is to thin, tighten, and flatten".

The different tummy tuck techniques that exist are selected based with the above goals in mind and tailored to the individual needs of the patient. Since the unique characteristics of a 30 yo females body which for example has had two kids defers from that of a patient who has experienced significant weight loss, the tummy technique that will best be able to accomplish the above goals will naturally be dramatically different as well.

We will start later this week with mini abdominoplasty and progressively advance to more extensive tummy tuck techniques.

All the best,

Dr. Remus Repta

What is a tummy tuck?

2008-08-28T20:48:00.000-07:00

The majority of people would be able describe the basic idea of a tummy tuck. Most people know that it is a plastic surgery procedure designed to improve the appearance of the abdominal area and that the secondary result is a scar that is located near the lower waist. While this is the essence of the standard tummy tuck, the components that allow for a truly remarkable cosmetic result are not often known. In addition, few people know that there are quite a few different type of tummy tuck procedures. Enough to fill an entire plastic surgery textbook. Over the next handful of posts I will take you through the myriad of tummy tuck procedures that are available. We will also discuss the ideal candidates for each type of procedure, the benefits as well as the drawback of each procedure, and some of the recovery/what to expect issues.

Below I have composed a rough list of the tummy tuck procedures available. We will go through each one in successive fashion approximately one every week. If substantial discussion develops on any one technique or if there are other tummy tuck topics that arise in between each session then the next session will follow in time.

All the best,

Remus

Tummy Tuck techniques
Endoscopic
Mini
Full
Extended
Circumferential
Fleur-de-Lis
Reverse
Liposuction
Tummy tuck with lymphatic preservation
Related body contouring procedures

All the best,

Dr Remus Repta

Welcome

2008-08-27T17:56:00.000-07:00

This is the first entry in what I hope will become the primary site for information sharing concerning the tummy tuck procedure. I encourage anyone with questions, concerns, or information regarding tummy tuck to post here.

The tummy tuck procedure can be a wonderful way to rejuvenate the appearance of the abdomen. In the words of one of my mentors, the tummy tuck procedure can "thin, tighten, and flatten" the shape and contour of the abdomen. Since every patient and abdomen is different, a unique tummy tuck technique must be selected to deliver the best result possible.

Recently released, The Atlas of Abdominoplasty, is a comprehensive plastic surgery textbook on the tummy tuck and the related body contouring procedures. It is 15 chapters and covers all of the different tummy tuck techniques. In addition to sharing information and answering questions I will periodically post the details about each unique type of tummy tuck procedure, the ideal candidate, the recovery process, as well as some of the pros and cons associated with each procedure.

All the best,

Dr Remus Repta